Migraine headaches are common in young women and can be extraordinarily incapacitating requiring longterm treatment with medications. Similar to the account of the discovery of a cure we observe migraine headaches not infrequently in our Caribbean plastic surgery practice at Trinidad Institute of Plastic Surgery in younger women presenting for facial rejuvenation with Botox.
Chance plays a big role in medical progress. But luck only meets the prepared mind. A decade ago a plastic surgeon observed that migraine headaches in certain instances disappeared in women receiving Botox injections in the eyebrow and forehead area for cosmetic purposes. Systematic study of this phenomenon resulted in the hypothesis that compression of the forehead nerves by the eyebrow muscles may trigger migraine attacks. These very muscles (corrugators, depressors, procerus) are the target of cosmetic Botox injections. Nerve compression is eased and migraine attacks decrease in frequency and severity once the Botox effect relaxes the corrugators/depressor/procerus complex. However, once the Botox effect wanes after three to four months, headache severity and frequency increased again. Evidence supporting a trigger point/nerve compression theory accumulated when it became apparent that permanent nerve decompression by resection of the compressing corrugator muscles as done during forehead and eyebrow lifting and rejuvenation resulted in a permanent decrease of headache severity and frequency.
After this initial success some types migraine headaches remained unresolved. Further investigations suggested that persistent headaches were related to the location – side of the head and back of the head. Research identified several additional nerves being compressed by surrounding muscles. The process of Botox injections into the areas of compression and surgical decompression was repeated. If Botox injections improved the headaches then this improvement could be made permanent by surgical decompression.
The final bastion was located in the nose. Correction of deviation of the nasal septum during septoplasty and rhinoplasty succeeded in improving headache frequency and severity in conjunction with nerve decompressions.
The path to discovery also outlines a treatment plan for proven migraine headaches with a roughly seventy percent chance of permanently decreasing the severity and frequency of migraine headaches. After confirming the diagnosis, Botox injections are preformed in the dominant compression areas sequentially. If the injections result in improvement, surgical nerve decompression is suggested.
The operation is performed as a combination of a brow lifting technique (most of the time as keyhole surgery with the use of an endoscope), decompression of nerves on the back of the head under magnification through an incision covered by most female hairstyles and a septoplasty or rhinoplasty using invisible incisions inside the nose.
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