How It Developed
Why It Works

How It Developed
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Migraine surgery initially developed through the efforts of Dr. Bahman Guyuron, in Cleveland, Ohio. Dr. Guyuron observed that patients that had injections of Botox Æ for cosmetic purposes, as well as those who underwent a surgical brow lift, had a remarkable resolution of migraine headaches. These headaches seemed to return as soon as the Botox Æ wore off. However, in the surgically treated patients, their freedom from disease appeared to be permanent.

Several surgeons, including Dr. Branch, trained with Dr. Guyuron during the development of the surgical technique, using a minimally invasive procedure and hidden incisions. After leaving Cleveland, these surgeons began performing these procedures within their own independent practices. They also began achieving similar results to Dr. Guyuron.

For the last two years, a Migraine Surgery Symposium has been held in Cleveland, Ohio, where physicians from University Hospitals Cleveland Clinic combine efforts to share the surgical technique with other plastic surgeons as well as a few neurosurgeons. Jennifer Kreigler, a neurologist from the Cleveland Clinic, did the original collaborative effort and research and Dr. Guyuron gave his perspective on the development of the field.
 
Dr. Branch and these other surgeons have been guest faculty members at the symposium, assisting Dr. Guyuron in the training of 50 to 60 surgeons from around the world in migraine surgery.  

Why It Works
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The hypothesis is that Botox Æ results in temporary weakening of the muscles that impinge on the nerves. Tension and irritation of these nerves by surrounding muscles (or by airway stimulation as in the case of migraines triggered by nasal septal deviation) causes the migraine generator and or blood vessels to be more excitable and likely to spike a headache. These nerve branches have been pinpointed as some of the trigger areas that cause migraine headaches and that often transmit the pain of the headache itself.

Botox Æ is a small dose of Botulinum Toxin that is injected to temporarily weaken the target muscles.

The trigger sites can be identified by Botox Æ injections in three of four trigger zones. In these three areas, weakening of the muscles causes 6-12 weeks of over 50% improvement in 70-80% of patients. This response to Botox Æ predicts a 90% success rate of the surgery.