Note to our followers: Our nearly 13-year run of daily publication of new content on HealthNewsReview.org came to a close at the end of 2018. Publisher Gary Schwitzer and other contributors may post new articles periodically. But all of the 6,000+ articles we have published contain lessons to help you improve your critical thinking about health care interventions. And those will be still be alive on the site for a couple of years.
Read Original Release

Surgery for chronic headaches? PR release strikes the right tone for making the pitch

Surgery for chronic temporal headaches -- simplified approach shows good results

Our Review Summary

headacheThis news release describes a modified surgical facelift procedure that may help treat a certain type of chronic headache. It’s based on a report written by a surgeon from the American Society of Plastic Surgeons, which was published in the Society’s latest journal issue.

The study was based on the surgeon’s experience performing the procedure on 19 patients with chronic headaches — commonly referred to as migraine — including a one-year follow-up to assess their migraine symptoms. The news release does a good job quantifying the benefits and describing the procedure but it leaves out some other information that would be helpful to readers such as possible complications from the intervention, limitations of anecdotal evidence, costs and funding sources.

The news release uses a tone befitting the nature of the problem and the nature of the evidence.

 

Why This Matters

Chronic intractable headaches inflict a huge toll — not only in terms of quality of life but also in time away from work or school and in treatment costs. Drugs commonly prescribed for chronic headaches often go beyond simple painkillers to include triptans (which block serotonin receptors), drugs that prevent migraine onset and tricyclic anti-depressants. Since migraines affect so many, another alternative to pharmacological treatment would be of wide interest. In 2010 the FDA approved botulinum toxin injections for the treatment of migraines after it was observed that the wrinkle treatment eliminated migraines in sufferers who sought the cosmetic treatment for facial wrinkles.

In this case, it appears that plastic surgeons observed a reduction in headaches among patients who underwent a cosmetic facelift of the forehead.

For those who can’t take — or don’t want — pharmacological treatment, surgery for chronic headaches could prove to be an option. It must be noted that surgery is an invasive procedure compared to other forms of therapy and carries a variety of risks, as well as high costs. Surgery to relieve chronic headaches seems to be a controversial topic, since some researchers doubt its effectiveness.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

There is no discussion of costs in the news release. Surgery to treat chronic severe headaches could prove to be expensive (ie. thousands of dollars), since the intervention may also require anesthesia, operating room facilities and a hospital stay.  Although costs may vary widely depending on the hospital and region, we believe a ballpark estimate would have been helpful.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The news release mentions that headache symptoms were assessed using the Migraine Headache Index (MHI), which is calculated by multiplying together the frequency, intensity, and duration of migraine headache, according to another paper published by the American Society of Plastic Surgeons.

Out of the 19 patients mentioned in this news release, 16 had at least a 50 percent reduction in headache symptoms.  It also reveals the absolute numbers, pointing out that the average MHI score decreased from approximately 132 points before surgery to 52 points afterward.

Since the release communicates a quantitative estimate by giving both absolute and relative benefit data, we give it a Satisfactory rating here.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release stated that “None of the patients experienced complications, and there was little or no visible scarring.” But the published study noted that neurapraxia (a temporary loss of nerve function) lasting several weeks was a risk. Although none of the 19 patients experienced complications, it would have nevertheless been helpful to describe possible risks in the news release.

Most interventions carry risks, and the Gillies incision used in this procedure is no exception. Complications from the procedure could result in injuries to the wall of the eye and cosmetic deformities, as well as limitations in jaw movement.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The news release provides a straight-forward overview of the patient group — 19 people with a history of chronic headaches — along with a description of the procedure and how outcomes were measured using a standard score, the Migraine Headache Index (MHI), before and after the surgery. The release doesn’t tell us the age of the patients but it does tell us how they were chosen for the study. (“All patients had chronic temporal headaches that did not improve with medications. They also had a positive result on preoperative testing–either injection of botulinum toxin (Botox) to temporarily block muscle activity, or local anesthetics to temporarily block the involved nerve.”)

However, a brief discussion of the limitations of the study would have been beneficial, and we think necessary to include. The study was very small and was not randomized or blinded; there wasn’t a control group to compare outcomes between those receiving the intervention and those that didn’t. The results are very likely to be biased, but the release really gives no sense that these results are limited in any way.

Does the news release commit disease-mongering?

Satisfactory

There is no disease mongering in the news release. On the contrary, it’s quite balanced in its tone.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

The news release does a good job of disclosing the fact that Dr. Ziv M. Peled of Peled Plastic Surgery is a Member Surgeon of the American Society of Plastic Surgeons (ASPS). It isn’t clear, but it seems the 19 patients mentioned in the release were Dr. Peled’s private patients.

Although we would have liked this to be explicitly stated, we feel this earns a Satisfactory rating.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

Surgery is one of the most invasive interventions to treat chronic temporal headaches, but other alternatives exist — like drug therapy. Some antidepressants, beta blockers (to treat high blood pressure), anti-seizure medications and nonsteroidal anti-inflammatory drugs could provide relief, as well as Botox injections.

Since none of these alternatives were mentioned, we give the news release a Not Satisfactory rating here.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The release isn’t clear whether or not the surgery is currently available specifically for chronic headache patients. From an online search, it seems that some centers do offer surgery to treat chronic headaches, although it isn’t always clear  what techniques the surgeons use.

Does the news release establish the true novelty of the approach?

Satisfactory

The Gillies incision is not a new procedure, as it has been in use since 1927. The news release makes this clear, explaining that many surgeons are already familiar with this approach, which is used to repair cheekbone fractures.

The news release also points out this paper adds to the “already growing body of research showing good outcomes with surgery for chronic temporal headaches” — again suggesting that the idea is not completely novel.

We feel this is good enough to merit a Satisfactory rating.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

Overall, the news release did not use unjustifiable and sensational language, which is why we give it a Satisfactory rating.

Total Score: 5 of 10 Satisfactory

Comments

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.