COSMETIC EYELID SURGERY MAY EASE MIGRAINES
Cosmetic eyelid surgery involving specific nerves may do
more than improve your looks — the procedure may also provide migraine relief
for some, according to new research.
The technique involves making incisions in the upper eyelid to
deactivate so-called “trigger” nerves. This process also lifts the lid, a
technique known as blepharoplasty.
The new approach is an alternative to another surgery sometimes
used to treat migraines. That one approaches the nerves under the skin but
starts at the scalp.
Both procedures are known as trigger-site deactivation surgeries.
Some neurologists and others who care for people with migraines view the
procedures as unproven.
But when the surgery is used in appropriate patients, migraine
improvement is common, said study researcher Dr. Oren Tessler, an assistant
professor of clinical surgery at the Louisiana State University Health Sciences
Center New Orleans School of Medicine.
“Ninety percent of our patients had over 50 percent improvement in
their migraines,” he said. “After a year’s time, 51 percent had no migraines.”
“As a bonus they got an upper eyelid surgery,” added Tessler, who
is also director of plastic surgery at University Hospital, New Orleans.
Not everyone agrees that this surgery is helpful, or even that
freeing trapped nerves gets to the root of what causes migraines.
“I think it’s conceivable at least in principle that a nerve could
be trapped,” said Dr. Vincent Martin, co-director of the headache and facial
pain program at the University of Cincinnati School of Medicine in Ohio.
Martin said that while entrapped nerves may worsen migraines, he’s
not convinced that they’re a cause of migraines.
In addition, “There are weaknesses in the way the study was
designed,” he said, citing the lack of a control group. All 35 patients had the
surgery so they couldn’t be compared against a “sham” surgery group, a common
method in scientific studies.
“There’s a huge ‘placebo effect’ from surgical procedures,” Martin
explained. In other words, they may think they feel better simply because they
received treatment.
The study, published online recently in Plastic and
Reconstructive Surgery, included 30 women and five men. Their average age
was 46.
Tessler said patients have to be selected carefully because the
surgery is meant for those whose migraines are caused by a compression of nerves
as they exit the skull.
“You release the nerve and you remove the irritation,” Tessler
said.
In his study, the average number of headache days reported by
patients declined from 18.5 a month on average to fewer than four a month one
year after the surgery.
“There have been no major complications,” he said. “Every patient
will have some numbness because the nerve is in shock.” That numbness usually
resolves, but a small amount may remain, he said. His patients tell him it’s a
small price to pay for migraine relief.
The fees for the surgery, done as a cosmetic procedure, vary by
doctor and region of the country. According to the American Society of Plastic
and Reconstructive Surgeons, the average physician fee is about $3,000. The fee
does not include any charges for the facility and anesthesia.
Tessler said the surgery, sometimes covered by insurance, takes
about three hours. An incision is made in the upper eyelid to get to the
specific nerves and release them. “It [also] takes away the bulge of the
eyelid,” he said, giving a more youthful look.
Acknowledging the small study size, Tessler said more research is
needed. None of the researchers disclosed financial interests in any of the
products, devices or drugs discussed in the study.
Martin also believes more study is needed. This technique is
“theoretically plausible, but not proven,” he said. “Most neurologists and
headache doctors don’t think the evidence is sufficient to recommend this
surgery at this time.”
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