Common plastic surgery procedure brings migraine relief

Nearly 30 million Americans suffer from migraines, severe headaches that can be extremely painful and debilitating.

They can prevent people from working, socializing and living normal lives.

Now, a common plastic surgery procedure may be the key to stopping the pain.

Susan Neuberger does not take any pain-free second on the job for granted. She suffered from migraine headaches for 33 years.

“It felt like somebody was stabbing me. I missed work at least once every two least,” she said.

Susan took medications for years, but never experienced relief. Then, she met Dr. Silvio Podda. He had read an article about a plastic surgeon who performed brow-lift surgery on 40 migraine patients.

"Out of those 40 patients, all of them who had done the procedure, they never had any more episodes of migraine,” Dr. Podda said.

Dr. Podda suggested Susan try it since there are few risks to the common cosmetic procedure. First, Susan received Botox injections for a few months to temporarily paralyze muscles and nerves in her forehead. Then, Dr. Podda made two small incisions on the top of Susan's head and removed nerves and the glabella muscle, the one that gives people their frown expression. That simple release reduces the pain. A study conducted by members of the American Society of Plastic Surgeons found the brow-lift procedure completely eliminated migraines in 57 percent of patients. Doctor Podda said that is huge.

Susan said the day she went in for surgery changed her life.

"I have not had a migraine since that day. That was December 4, 2009,” she said. "When people say they were given a new lease on life, I really was by Dr. Podda, and that was the best day of my life."

Doctor Podda said there are not many risks to a brow-lift procedure.

A rare one is damaging the frontal nerve in the face.

Susan had several of her doctors write letters to her insurance company, which ended up covering the entire cost of her surgery.

Research Summary:

BACKGROUND: According to the Mayo Clinic, a migraine headache can cause intense throbbing or pulsing that is often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can cause pain that lasts for hours to days. Sometimes, sensory warning symptoms (aura) such as flashes of light, blind spots or tingling in the arms or legs can precede a migraine. These headaches often begin in childhood, adolescence or early adulthood. They are often under-diagnosed and untreated.

WHY DO THEY HAPPEN? Doctors don't know exactly what causes migraines, but they believe genetics and environment play a role. Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, which is a major pain pathway. Other factors like imbalances in brain chemicals, including serotonin, may also be involved. Serotonin levels fall during migraine attacks, and some believe this may trigger a person's trigeminal system to release substances called neuropeptides, which travel to the brain's outer covering. The result is headache pain.

TRIGGERS: There are many triggers for migraine. These may include:
* Hormonal changes: In women, fluctuations in estrogen seem to trigger headaches in those with known migraines. Women with a history of migraines often report headaches immediately before or during their menstrual cycles, when they have a drop in estrogen. Others tend to suffer from migraines during pregnancy or menopause.
* Foods: Common foods that may trigger a migraine include alcohol, aged cheeses, chocolate, aspartame, caffeine, monosodium glutamate, salty foods and processed foods.
* Stress: Stress at work or home can trigger migraines.
* Sensory stimuli: Bright lights and loud noises can trigger the headaches as well as unusual smells.
* Changes in sleep patterns: Missing sleep or getting too much sleep may be triggers for migraines.
* Environment: A change in weather or barometric pressure can prompt a migraine headache.
* Drugs: Certain medications can aggravate migraines.

PLASTIC SURGERY FOR MIGRAINES? Some doctors are using plastic surgery as a way to relieve the pain associated with migraine headaches. In one study, two neurologists and a member of the American Society of Plastic Surgeons investigated the effects of a brow lift procedure that included the removal of the migraine-triggering nerve areas. Of the 49 patients who had this procedure, 83 percent said that they were suffering from migraines half as frequently as they did before. More than half of the patients reported that their migraines had been completely eliminated.

Nancy Collins
Director, Public Relations/Marketing
St. Joseph's Healthcare System

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