Surgery may help teens with migraines

Migraine surgery may be an effective choice for teens who haven’t gotten relief from standard treatment, a study suggests. In the study, researchers at Case Western Reserve University School of Medicine in Cleveland reviewed the medical records of 14 patients, with an average age of 16.

In teens with migraine who haven’t responded well to other treatments, “migraine surgery may offer symptomatic improvement of migraine head-ache frequency, duration and severity in patients with identifiable anatomical trigger sites,” wrote the study’s authors.

However, at least one head-ache expert questioned the value of the procedure, citing a possible placebo effect. Results of the study were published in the June issue of Plastic and Reconstructive Surgery. Migraines are recurring bouts of moderate to severe head pain, according to the US National Institutes of Health. As many as 8 per cent of children and teens experience migraines, said the study’s background information.

Options for treating migraine in teens include over-the-counter pain relievers, the nasal medication sumatriptan (Imitrex), and a preventive medication called topiramate, according to the study authors. A previous study found that nearly one-quarter of teens treated still had migraines after treatment. The current study looked at whether or not surgery might be an effective option for these teens.

The surgery involved is actually a plastic surgery procedure that decompresses a nerve or releases a trigger point that is believed to cause the migraine. The surgery was developed after doctors noticed that migraine patients who underwent certain cosmetic procedures, such as a forehead lift, had fewer headaches afterward, according to the study’s lead author, Dr Bahman Guyuron, an emeritus professor of plastic surgery at Case Western. Guyuron developed the techniques used in the migraine surgery.

There are several sites in the head and face that are considered common trigger sites for migraines, Guyuron said. Before surgery, patients are asked to keep a diary of their migraine symptoms and to note where headaches start. The trigger site can also be confirmed either by injecting a small amount of local anesthetic at the site to see if a migraine eases up or by using a Doppler ultrasound device to check blood vessels that might be impinging on nerves.

All of the procedures were performed by Guyuron. Follow-up averaged more than three years. Five patients were free of migraine symptoms after their surgery, the findings showed. For those still experiencing headaches, the average frequency of migraines for the teens over a 30-day period went from 25 to five.

The duration and severity of their headaches also decreased. One patient didn’t have improvement in the frequency of headaches, but did have less severe headaches with shorter duration, according to the study.

Still, not every teen who has migraines is a candidate for surgery, the study authors pointed out. Surgery should be reserved for teens whose migraines have not responded to other treatments and who are likely to continue to have them as adults, Guyuron said.

Migraines in the family

“Some teenagers outgrow migraine headaches,” he said. It is important to look at pattern of migraines in the family. If family members have migraines that continue past the teen years, “it is almost a given that the teenager will continue to have migraines in adulthood,” he said. However, the surgery, which is performed by plastic surgeons, is controversial for both teens and adults among headache and migraine specialists.

Migraine surgery is not reversible and can have long-lasting implications, said Dr. Andrew Hershey, a spokesman for the American Migraine Foundation, and director of neurology at the Cincinnati Children’s Hospital Medical Centre. He said there have been flaws in how the studies of the surgery in adults have been done, such as a lack of a control group.

This study of migraine surgery in teens didn’t have a control group, which means the results may be due to a placebo effect, Hershey added. “The placebo effect can be as high as 70 per cent with kids’ disorders,” he said. Because migraines come and go naturally, it may seem that there has been an improvement, he explained.

“This is not a proven treatment,” Hershey stated. He added that the surgery is expensive and may not be covered by health insurance. Guyuron said he doesn’t think the results are due to a placebo effect. “I have at least 400 patients without migraine headaches for at least 14 years,” he said, adding that several studies of migraine surgery have been published showing good results.