Plastic Surgery for Migraines

There have long been rumors that facial plastic surgery can ease chronic migraines; this idea is at least 20 years old, and I suppose it got started when some facelift patient told her doctor, "oh, my migraines are gone." The idea is that the surgery reduces the irritation of facial nerves that trigger the headaches. Botox has lately been used the same way, and it has become such a common off-the-books procedure that the maker of Botox is pursuing approval of this treatment from the FDA. Now a major double-blind study has been done of facial plastic surgery as a migraine treatment, and the results are promising:

No wonder that earlier last month, news of a surgical “cure” that touts a high success rate ricocheted worldwide. The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who underwent surgery in one of three “trigger sites” significantly reduced their number of headaches compared with more than 55 percent of the group who had sham surgery. More than half of the patients with the real surgery reported a “complete elimination” of headaches compared with about 4 percent of the placebo group.

But look at that placebo group number: 55 percent who had sham surgery reported significantly fewer headaches. That is the whole problem with trying to make treatment for head or back pain scientific. Pain happens in our heads, and everything from our mood to the color of the room we are in can affect how much pain we say we feel. There have been numerous reports of miracle drugs for migraines over the years, but in every case it turns out that the very high success rate of initial studies is largely the placebo effect of something touted as a new miracle drug, and that as the drug becomes routine, its effectiveness declines.

The doctors cited in the NY Times are concerned that there will be a rush of people trying to get the procedure, because some of them think it will only work for people whose headaches start with facial pain. My own headaches, which gave me a great deal of trouble in my late teens and early twenties, turned out to be related to my allergies, and now that I have my allergies under control I have a bad migraine only two or three times a year. But if that result of 50 percent reporting complete elimination of their headaches holds up, this will be a miracle cure for many, many people.