Approximately 30 million people suffer from migraines in the United States. And for many, relief may be found by releasing specific muscles around the head that exert pressure on certain nerves. In fact, the most common trigger point is the brow area, which can be alleviated by performing an upper facelift or brow lift. Called the “migraine lift,” it’s effective for both severe episodic and chronic refractory migraines, according to Adam Hamawy, M.D., F.A.C.S., owner and director of Princeton Plastic Surgeons in Princeton, N.J.
“As with many findings in science, the discovery of this technique was accidental,” Dr. Hamawy tells The Aesthetic Channel.
An Ohio plastic surgeon, Bahman Guyuron, M.D., discovered incidentally that many of his facelift and brow-lift patients had a reduction in migraines. “By investigating the anatomy and what structures were released during the procedure, Dr. Guyuron found that the supraorbital nerve and the zygomaticotemporal nerve were released, thus causing some migraines to disappear,” Dr. Hamawy says.
Dr. Guyuron also noticed that his Botox patients were experiencing the same migraine relief. “However, whereas Botox relaxes those muscles for about 3 months at a time, surgery releases those muscles permanently,” Dr. Hamawy says.
Dr. Guyuron first published his findings in 2000, and now there are over 50 articles in peer-reviewed journals about this technique.
In a 2009 study in the journal Plastic and Reconstructive Surgery, Dr. Guyuron reported the results of a placebo-controlled surgical trial of his technique for the treatment of migraine headaches, which found that compared to the placebo group the treatment group achieved statistically significant improvements in all validated migraine headache measurements at 1 year.
“One of the criticisms against this technique is that the improvement is simply a placebo effect from undergoing the surgery, not from the specific release of the triggers,” Dr. Hamawy explains. “The study basically debunks that myth.”
Dr. Guyuron was also lead author of a 5-year outcome study of surgical treatment of migraine headaches that appeared in 2011 in Plastic and Reconstructive Surgery, which concluded that 88% of patients observed a positive response to the surgery after 5 years. Also, that 29% reported complete elimination of migraine headache and 59% had a significant decrease.
“We now have experience to show the effects of surgery last more than 10 years,” says Dr. Hamawy, who has personally performed the procedure since 2008 in more than 50 patients. “I have seen improvement in every single one of my patients, with many achieving complete resolution of their migraines. The remaining patients see a significant reduction in frequency and intensity.”
Dr. Hamawy notes that patients with migraines have usually exhausted all other treatment modalities, “so they end up doing a lot of the research on their own.” Patients normally find the doctor either by word of mouth or via the internet. “However, coming to a plastic surgeon for migraine is not intuitive,” Dr. Hamawy says. “I am also not in the business of diagnosing migraines, so I usually ask the patient to be diagnosed by a neurologist before considering surgery.”
Migraine Trigger Points & Procedures
Once the origin of the migraine is isolated, including the back of the head where the greater occipital nerves are compressed, Dr. Hamawy will often conduct a Botox trial, injecting specifically around the targeted nerves. “If the Botox works, which is about 80% of the time, the surgery should be effective,” he says.
There are four common migraine trigger points: the brow, temple, back of the head and inside the nose. For migraine origination in the brow area, an endoscopic brow lift is scheduled, whereby the corrugator muscle is removed. “An added benefit of this particular technique is that people do not frown anymore,” Dr. Hamawy conveys.
For origination in the temple area, the zygomaticotemporal nerve is cut endoscopically. “Patients end up having a small numb area on their scalp,” Dr. Hamawy says.
For the back of the head, a roughly 2-inch incision is made inside the hairline, over the occipital prominence and down to the greater occipital nerve, where large muscles such as the trapezius and the semisplinalas capitis reside. “We release the pressure from around the greater occipital nerves,” Dr. Hamawy says. “By removing a cuff of muscle, this allows the nerve to travel freely without compression.”
The fourth most common area of migraine origin is inside the nose, stemming from the pressure of a severely deviated septum or a septal spur. “Performing a rhinoplasty to correct the septum should alleviate the migraine,” Dr. Hamawy says.
Nearly 80% of patients overall have more than one trigger area for their migraine, with 50% of patients needing a brow lift and 30% temporal surgery. And about 20% of all patients are afflicted with all four origination points.
Dr. Hamawy often performs surgery in one session, even for multiple locations. Each trigger area takes about 45 minutes to treat under general anesthesia. “On average, surgery takes 3 to 4 hours,” he says. “Most people experience relief of their chronic headaches upon waking up from surgery.”
Most patients also go home the same day. Still, Dr. Hamawy recommends about a week off from work.
For plastic surgeons already familiar with endoscopic brow lifts, the learning curve is minimal, according to Dr. Hamawy. But for those unfamiliar, “it takes at least 25 operations to become comfortable.”
Dr. Hamawy points out that although the migraine lift has been around for nearly 20 years now, “it is a shame that more people do know about it, considering that approximately 30 million people in the United States suffer from migraine headaches. This is a life-changing operation. These are some of the happiest patients I have treated.”