How Botox can knock a migraine on the head
By Nigel Hawkes
Research shows wrinkle drug can reveal muscles in the face and neck that trigger headaches

MIGRAINE can be treated successfully by using Botox to identify the muscles triggering the headaches and then removing them surgically, an American study indicates.

A very common and disabling condition, migraine is suffered by as many as six million people in Britain, 10 per cent of the population. It is by far the most common neurological condition, more common than diabetes, epilepsy and asthma combined.

Most people treat their migraine attacks with painkillers but the group of patients taking part in a small British trial had a much more radical treatment.

For several years Bahman Guyuron, a plastic surgeon at Case Western Reserve University in Cleveland, Ohio, has argued that migraines are triggered by muscles in the face and neck. He came up with the idea after finding that patients who had had a “forehead lift” to remove furrows subsequently suffered less from migraine.

The idea is controversial because most experts believe that migraines are neurological, caused by changes in the brain and not by muscle tension. So Dr Guyuron set out to do a proper trial. He used Botox injections, which paralyse the muscles, to identify which were responsible in each patient and found four distinct areas — the forehead, temple, back of neck and around the nose.

The 89 patients then underwent surgery to remove the muscles. In Plastic and Reconstructive Surgery, he reports that the frequency, intensity and duration of the migraine attacks were reduced for 92 per cent of the patients studied and eliminated for 35 per cent.

Patients were able to lead much more normal lives after surgery. Beforehand they missed on average 4.4 days of work each month. Afterwards they missed just 1.2 days. The treatment also reduced the annual cost of migraine care for the patients from around £3,900 to £480.

Dr Guyuron said: “The economic impact of migraine headaches on businesses is staggering due to the loss of employee time and productivity. By identifying the trigger areas for migraines and performing targeted surgical procedures, we significantly reduced or eliminated their migraines and the amount of time missed from work.

“Before surgery my patients expressed extreme frustration at not being able to gain control of their lives. They wanted to work or spend time with their family. Through our new surgical discoveries we are able to help patients escape the awful effects of migraines and start living their lives again.”

Dr Guyuron’s work has proved controversial in the US where some neurologists have claimed that muscles are simply not involved in migraines. But he says that the results speak for themselves.

Alan Bartle, chief executive of the Migraine Trust, said new approaches were welcomed. “This study would seem to indicate that for a defined subgroup of patients with migraine this may be an approach worth considering following proper diagnosis and after other treatment options have been tried,” he said.

But Mr Bartle said other studies into the use of Botox injections alone had so far proved inconclusive.

“This latest study is a further procedure, which is invasive and does show some sideeffects. I would wish to see further studies with fully randomised, double-blinded, placebo-controlled trials among significant numbers with long-term follow up before being able to comment,” he added.