Corrugator muscle surgery and the Migraine Trust

This month the Migraine Trust issued a press release regarding "corrugator muscle surgery".  Wendy Thomas, the CEO for the Migraine Trust, went on record to say that they would not recommend this type of surgery for migraine.  The main reason was "insufficient evidence" that this type of surgery is effective.

Some researchers have suspected that there is evidence that this type of surgery may help people because of the way Botox has helped some with chronic migraine.  Is Botox impacting the muscles in a temporary way, and if so can surgery make the improvement permanent?

Of course, saying that there’s generally "insufficient evidence" does not mean that this type of surgery never works, and it does not mean that it might not be a promising area of research.  But there are some reasons why we can’t jump too quickly onto the bandwagon.

First, we don’t know exactly why Botox works.  We can’t assume that we know, because there are a number of complex biological changes happening in Botox treatment.

Second, there has been a very limited amount of research done in this area.

Third, we need to remember that this type of surgery, if it does work in a widespread way, is likely eliminating a trigger, but not a cause.  That means that the migraine attacks could return after surgery, even if it isn’t right away.

On the other hand, just because this is not a treatment for the majority of migraine patients at this point, we shouldn’t completely abandon the research.  It’s one thing to point out to patients that there are many better options to try, it’s another thing to jump to the conclusion that there is no promise in this area of research at all.

Remember that there are many, many treatments available, and also many, many lines of research in this day and age.  This should never be the "only hope" of future treatment for a migraineur.

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6 comments… add one
  • My Migraine Surgery Jun 18, 2011

    I actually am a year out from having Migraine surgery.
    The above article erroneously makes no reference to the most current Double-blind surgery done in 2009 by Dr. Guyron and other that draws the following: “Concusion: This study confirms that surgical deactivation of peripheral migraine headache trigger sites is an effective alternative treatment for patients who suffer from frequent moderate to severe migraine headaches that are difficult to manage with standard protocols.” To anyone who deals with migraines, do the research yourself. The study I refer to is located at http://www.ncbi.nlm.nih.gov/pubmed/19644260?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus There have also been Sham Surgery studies done, which are the most difficult form of study to get approval for because there is actually a ‘placebo’ surgery called a sham surgery study done. The insurance companies refer to the fact that there were only 75 people in the study so therefore it is considered “experimental.” The reason for the lower number is because of the fact that surgery is involved. The insurance companies would rather take the kickbacks from pharmaceutical companies and keep patients medicated long term rather than pay for surgery that can heal. In my case, over one year out from surgery in three trigger zones, I have only had ONE migraine. I have also spent the past year going through a divorce and the most painfully difficult time of my life moving out of my home as well. That being said I have only had ONE migraine in one+ year . I had them for the 30 years prior, and I was up to the point of 3-days long on practically a weekly basis. I do find it extremely ironic that this article doubting migraine surgery was posted after I made a comment after “liking” this page and mentioning my own surgery just earlier this very same week. It just goes to prove that you need to follow up on your own and trust your own gut instinct on what to do for your own body.

    • Dee Jul 16, 2011

      I agree with you. I think pharma companies as well as insurance companies would miss out on alot if a surgery was found to improve or cure migraines. They would rather continue making money off the drugs we buy and specialist visits. Your experience with the surgery has def given me something to think about since I’m at wits end with migraines.
      Thanks for your input.

  • James Jun 20, 2011

    Thanks for your input!

    We do have an article on Dr. Guyuron’s findings, posted in February:
    Dr. Guyuron’s Migraine Surgery, 5 Years Later

    I was actually trying to introduce some balance to the press release from The Migraine Trust. I felt it was overly negative. But to be fair, it was written, as I understand, in response to a BBC article. It helps to know all the background! 🙂

    Dr. Guyuron’s study is encouraging. But we have a ways to go before we really understand how many this may help, and who it may help. Financial reasons aside, there are other reasons to be cautious when it comes to this kind of surgery.

    Cautious does NOT mean everyone needs to avoid it. And my concern with the Migraine Trust release was that it seemed to completely write off the surgery, a reaction that I didn’t feel was warranted.

    So, although I encourage caution, I do NOT want to leave anyone with the impression that I’m against this kind of surgery and that I don’t recognize the research that has been done. The link to more information on Dr. Guyuron’s research was below the post. However, I should have been more specific.

    Thanks for providing a corrective to this discussion!

  • chris Jan 11, 2013

    The evidence for the corrugator and temporalis involvment in migraine is significant especially in the US. It is also significant that The Migraine Trust choose to ignore this.

    I had botox and also found it very effective – I had no migraines just headahe behind and around my eyes due to strong odours. I found that it is possible to control the corrugator muscle without the extreme of surgery by identifying the aspects of daily life that make you use them – and changing your regime or adapting by being aware and knowing when your likely to use them – such as: washing and showering to stop water, soap and shampoo going into the eyes; direct light low in the sky; flashing/strobe light; windy weather and stress/anger. But this alone is not enough, it is also clear that nitrates in food being converted into nitric oxide cause migraine and that has to be reduced. The most difficult for me and still unresolved is the nasal cavity and odours triggering the problem.

    • Dee Jan 21, 2013

      Odours are a trigger for me too. Freezing the corrugators and other forehead muscles with botox has not helped with my migraine auras, but only the pain. I get a heightened sense of smell with migraine which exasperates all of the other symptoms like nausea. My personal experience has lead me to believe that freezing muscles in area’s where pain is felt is only part of the solution. Botox does not stop the neurological cascade in the brain that leads to all of the other symptoms but only acts as a pain blocker.

  • chris Jan 28, 2013

    Dee – Could be deviated nasal septum; the nasal cavity is innervated by the trigeminal nerve. As you probably know there is a surgical procedure, I’ve no idea of the efficacy but would sure like to hear more on this, my sense of smell also goes through the roof along with the nausea, a thoroughly dreadful experience as all migraineurs well know.

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