Treatment of Headaches with Plastic Surgery

Abstract

Headaches affect millions of people a year and are associated with a great deal of morbidity. Though the causes of headaches are many, a subset of headaches refractory to traditional pharmacologic treatment — namely migraine and cluster headaches — can be treated surgically. All patients should undergo a thorough history and physical examination and evaluation by a headache specialist. Patients who are diagnosed with migraine headaches have potential trigger sites identi-fied by consideration of the constellation of symptoms, intranasal examination, CT scan, and by injection with 12.5 U of botulinum toxin A for each muscle involved. The use of botulinum toxin A as definitive treatment for headaches remains controversial; we use it as a diagnostic aid. Glabellar trigger sites are treated with corrugator supercilii resection, temporal trigger sites are treated with resection of the zygomaticotemporal branch of the trigeminal nerve (ZMTBTN), occipital trigger sites are treated with surgical release of the greater occipital nerve, and patients with intranasal triggers are treated with septo-plasty and inferior turbinate resection. Patients with cluster headaches are treated with resection of the ZMTBTN. Surgery does have a role in the treatment of refractory migraine and cluster headaches.