Cessation of Hairline Recession following Open Forehead Rejuvenation

Abstract

The purpose of this study was to investigate the efficacy of surgical deactivation of migraine headache trigger sites. Of 125 patients diagnosed with migraine headaches, 100 were randomly assigned to the treatment group and 25 served as controls, with 4:1 allocation. Patients in the treatment group were injected with botulinum toxin A for identification of trigger sites. Eighty-nine patients who noted improvement in their migraine headaches for 4 weeks underwent surgery. Eighty-two of the 89 patients (92 percent) in the treatment group who completed the study demonstrated at least 50 percent reduction in migraine headache frequency, duration, or intensity compared with the baseline data; 31 (35 percent) reported elimination and 51 (57 percent) experienced improvement over a mean follow-up period of 396 days. In comparison, three of 19 control patients (15.8 percent) recorded reduction in migraine headaches during the 1-year follow-up (p < 0.001), and no patients observed elimination. All variables for the treatment group improved significantly when compared with the baseline data and the control group, including the Migraine-Specific Questionnaire, the Migraine Disability Assessment score, and the Short Form-36 Health Survey. The mean annualized cost of migraine care for the treatment group (925 dollars) was reduced significantly compared with the baseline expense (7612 dollars) and the control group (5530 dollars) (p < 0.001). The mean monthly number of days lost from work for the treatment group (1.2) was reduced significantly compared with the baseline data (4.41) and the control group (4.4) (p = 0.003). The common adverse effects related to injection of botulinum toxin A included discomfort at the injection site in 27 patients after 227 injections (12 percent), temple hollowing in 19 of 82 patients (23 percent), neck weakness in 15 of 55 patients (27 percent), and eyelid ptosis in nine patients (10 percent). The common complications of surgical treatment were temporary dryness of the nose in 12 of 62 patients who underwent septum and turbinate surgery (19.4 percent), rhinorrhea in 11 (17.7 percent), intense scalp itching in seven of 80 patients who underwent forehead surgery (8.8 percent), and minor hair loss in five (6.3 percent). Surgical deactivation of migraine trigger sites can eliminate or significantly reduce migraine symptoms. Additional studies are necessary to clarify the mechanism of action and to determine the long-term results.

A systematic review of the psychosocial difficulties relevant to patients with migraine

“…With regard to prophylactic treatment, strong evidence exists that Topiramate is effective in improving both mental and physical health [24, 32, 49], while the evidence of the effect of beta-blockers such as Nebivolol and Metoprolol in improving physical health is limited [50]. Improvement in both physical and mental health after a surgical approach (deactivation of peripheral migraine headache triggers) was documented in two studies, but the evidence is limited [51, 52]. …”

Targeted Peripheral Nerve-directed Onabotulinumtoxin A Injection for Effective Long-term Therapy for Migraine Headache

“…1D–F) at the site of their migraine initiation. Patients were followed for the effect of BOTOX at this site, and additional trigger sites were addressed in a sequential manner if symptoms remained, per the original protocol published by Guyuron et al 22 A minimum of 1 month transpired between injections so as to precisely identify the incremental effect of each injection, allowing for identification of an individualized, patient-specific pattern of trigger sites.…”

Clinical Outcomes following Supraorbital Foraminotomy for Treatment of Frontal Migraine Headache

“…Fifty-one of these patients (64%) reported complete elimination of their symptoms and 28 (35%) reported significant improvement defined as at least a 50% reduction in frequency, duration, or intensity when compared to baseline. 9 While these results are encouraging, we believe that a partial response following surgical treatment of frontal MH is likely due to an unidentified site of compression. 15 …”

“…As a result of this discovery a surgical option is now available for patients refractory to standard medical treatment. 7–9,11–13 …”