This prospective study was conducted to investigate the role of removal of corrugator supercilii muscles, transection of the zygomaticotemporal branch of the trigeminal nerve, and temple soft-tissue repositioning in the treatment of
migraine headaches. Using the criteria set forth by the International
Headache Society, the research team's neurologist evaluated patients with moderate to severe
migraine headaches, to confirm the diagnosis. Subsequently, the patients completed a comprehensive
migraine headaches questionnaire and the team's
plastic surgeon injected 25 units of
botulinum toxin type A (
Botox) into each corrugator supercilii muscle. The patients were asked to maintain an accurate diary of their
migraine headaches and to complete a monthly questionnaire documenting pertinent information related to their
headaches. Patients in whom the injection of
Botox resulted in complete elimination of the
migraine headaches then underwent resection of the corrugator supercilii muscles. Those who experienced only significant improvement underwent transection of the zygomaticotemporal branch of the trigeminal nerve with repositioning of the temple soft tissues, in addition to removal of the corrugator supercilii muscles. Once again, patients kept a detailed postoperative record of their
headaches. Of the 29 patients included in the study, 24 were women and five were men, with an average age of 44.9 years (range, 24 to 63 years). Twenty-four of 29 patients (82.8 percent, p < 0.001) reported a positive response to the injection of
Botox, 16 (55.2 percent, p < 0.001) observed complete elimination, eight (27.6 percent, p < 0.04) experienced significant improvement (at least 50 percent reduction in intensity or severity), and five (17.2 percent, not significant) did not notice a change in their
migraine headaches. Twenty-two of the 24 patients who had a favorable response to the injection of
Botox underwent surgery, and 21 (95.5 percent, p < 0.001) observed a postoperative improvement. Ten patients (45.5 percent, p < 0.01) reported elimination of
migraine headaches and 11 patients (50.0 percent, p < 0.004) noted a considerable improvement. For the entire surgical group, the average intensity of the
migraine headaches reduced from 8.9 to 4.1 on an analogue scale of 1 to 10, and the frequency of
migraine headaches changed from an average of 5.2 per month to an average of 0.8 per month. For the group who only experienced an improvement, the intensity fell from 9.0 to 7.5 and the frequency was reduced from 5.6 to 1.0 per month. Only one patient (4.5 percent, not significant) did not notice any change. The follow-up ranged from 222 to 494 days, the average being 347 days. In conclusion, this study confirms the value of surgical treatment of
migraine headaches, inasmuch as 21 of 22 patients benefited significantly from the surgery. It is also evident that injection of
Botox is an extremely reliable predictor of surgical outcome.