Institute for Plastic Surgery 
Phone: 217-545-6314
Fax: 217-545-2588
E-mail: plastics@siumed.edu 
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Dr. Nicole Sommer in varios settings at SIU

SIU Migraine Clinic

History of Botox® in Migraine Headache Management

Dr. Guyuron, the pioneer and leading researcher of migraine surgery, as well as other plastic surgeons, noticed patients who underwent Botox® injections to reduce lines and wrinkles on the face also enjoyed the added benefit of having fewer migraine headaches. Many cosmetic patients who also suffered from migraine headaches who had brow lifts actually reported relief from migraine pain. This discovery led to the development of surgical treatment for patients who had not responded to traditional treatment of migraines.

During the process of surgically treating migraines, Botox® injections are used to determine which muscles in the forehead, back of the head, or temples (frontal, occipital, and temporal regions) may be causing the migraines. Botox® injections temporarily weaken the muscles that may be points of compression, irritation, or pressure on adjacent nerves and nerve bundles that then cause the migraine pain. An initial step in the migraine surgery evaluation is the determination of the primary migraine trigger zone and any additional secondary trigger zones. Determination of the migraine zone is based on review of a patient's medical history and 4 week migraine headache diary, physical exam and response to Botox®.

Botox® as diagnostic test

Botox® is also used as a diagnostic test to determine what trigger point(s) is causing the migraine and to determine if a patient with chronic, intractable migraine headaches will benefit from a more permanent surgical solution. The surgical technique -- performed by only a handful of plastic surgeons in the U.S. -- includes using Botox® to pinpoint which of several specific muscles in the forehead, back of the head or temple areas may be serving as trigger points to compress, irritate or entrap nerves that could be causing the migraine. Because Botox® temporarily inhibits muscle contraction, usually for about three months, it can be used as a trial test to see if a patient's migraine headaches go away or become less intense following a Botox® injection.

If a Botox® treatment is successful in preventing migraines or lessening their severity, then surgery to remove the triggering muscle is likely to achieve the same result, possibly permanently. Botox® treatments are used to determine if a patient will likely benefit from surgery. If a patient improves following a Botox® treatment to the trigger areas, they will likely benefit from surgery. If no benefit is seen following Botox® treatment, then it is unlikely that the patient would respond from surgery. Strict treatment algorithms and guidelines have been developed that includes administering Botox® to determine if a patient is an appropriate surgical candidate. Botox® injection is an essential component of the migraine surgery evaluation.

Plastic surgeons that perform these surgical procedures typically will only see migraine patients who have been diagnosed with recurrent migraines by a neurologist or pain management specialist and who have failed standard conservative migraine therapies.

Botox® treatment for migraine headaches

Botox® injected into the muscles of the brow, eyes, forehead, side of the head and back of the head near the neck has been found to provide migraine relief reducing both the frequency and severity of migraine attacks. Botox® has been reported to provide benefit to patients for up to six months and may cause fewer side effects than many of the standard medications used to treat migraines.

Migraine Surgery

History of migraine surgery:  Botox® to Surgery

Migraine surgery developed from the pioneering work of Dr. Bahman Guyuron, in Cleveland, Ohio. Dr. Guyuron observed that patients who had injections of Botox® for cosmetic purposes and patients who underwent brow lift surgery incidentally noted a significant reduction of their migraine headaches. In Botox® treated patients the headaches returned when the Botox® wore off. In the surgically treated patients the positive effect was permanent. Many patients achieved complete elimination of their migraine headaches following this type of cosmetic surgery.

Dr. Guyuron and his colleagues have demonstrated that 70-80% of migraine patients undergoing Botox® injections achieve a 50% improvement in frequency, severity and duration of migraines. Botox® has been shown to be an excellent predictor of migraine surgery success. A positive response to Botox® predicts a 90% success rate for migraine surgery, with 35% of surgical patients achieving complete elimination of the migraines (migraine cure) and the remaining achieving a significant permanent reduction in their migraine frequency, severity and duration.
Dr. Sommer is the first plastic surgeon to bring this beneficial surgical treatment for migraine sufferers to the Springfield area. Dr. Sommer is one of only a handful of surgeons in the United States who perform Botox® injections as a diagnostic tool to determine migraine trigger points that are amenable to surgery.