Migraine Treatments

Treatment for severe migraine headaches

There is a growing body of medical literature indicating beneficial effect in migraine prophylaxis by paralysing or decompressing certain forehead muscles and nerves. This was initially an incidental finding following the use of muscle relaxing injections to relax the muscles of the forehead for the long-term removal of frown-lines.

This purified protien is used to provide long-term relaxation (3 to 6 months) of selected muscles.

The reason for such outcomes is still being debated. The most popular hypothesis suggests that prolonged contraction of over-active corrugators (forehaed muslces) lead to nerve compartment syndrome of the supratrochlear nerve, a branch of the trigeminal nerve. This in turn causes some degree of nerve ischaemia with consequent release of neuro-peptides from the nerve fibres causing neurogenic inflammation of the nerve and meninges.

The importance of the trigeminal nerve as a component of the pathogenic pathway for migraine headaches, has been studied for many years but its role in migraine genesis has not been identified until recently.

Some clinical researchers advocate surgical intervention for migraine prophylaxis, if the patients have a good response to this injectable treatment. At APSA, we follow a strict case-selection protocol for these patients. They are assessed to exclude organic causes for the headaches; usually requiring a neurologist's consultation. The patients are then required to keep a log-book for one month prior to commencing treatment. The log books are used to identify the site, severity and frequency of headaches prior to trial treatment. Log-book keeping is repeated after the first treatment.

If patients respond well to this then they are offered the option of continuing with this treatment or permanently ablating the relevant muscles or nerves. These surgical manoeuvres aim to produce minimal functional or cosmetic morbidity.