This story suggests there may be a miracle cure for migraine headaches that has yet to make its way into the evidence base of the American Academy of Neurology 2007 guidelines on migraine headache. The newscast includes a brief interview with a single patient whose debilitating migraines (“something of a nightmare”) responded to no previous treatment, but disappeared after she had a forehead lift. (“It was a gift. And it gave me my life back.”) It also features a single expert, a plastic surgeon who performs facelifts and is the lead author of a recent randomized trial comparing plastic surgery to sham surgery for migraine.
The news story cites the surgeon’s study as evidence, but leaves out important details. Fully 35% of people who received surgery had complications–including “a slight degree of temple hollowing,” intense itching, persistent forehead numbness and neck stiffness, “slight asymmetric eyebrow movement,” and temporary hair loss or thinning—but the newscast ignores these. It also fails to note an intriguing placebo effect in the trial—people also improved if they received sham surgery for migraines. Why is that?
Other questions remain unanswered: Is it possible to reliably select people for this procedure—a process that requires an expert to identify a single or predominant trigger site for patients’ migraines? Is it possible to truly blind people to a treatment that includes a forehead lift? What does the procedure cost? Why doesn’t it eliminate headaches in the other 43% who get facelifts? Aren’t there other treatments we should know about—including lifestyle changes, physical and psychological treatments, and first-line migraine-specific drugs (see “Treatment Options”)?
To our eye, it seems likely the report will send migraine sufferers running to plastic surgeons for facelifts, despite its (slightly disingenuous?) claim to the contrary.
There is no mention of cost.
The newscast accurately states that 57% of people who received facelifts reported complete relief from migraine. But it neglects to mention the average follow-up was one year (potentially important), and ignores altogether the patients in the sham surgery group—many of whom also got better with fake facelifts. Yet the story refers to the approach as a "cure."
In the newly published randomized trial, 49 people received plastic surgery. The authors of the study reported adverse effects of surgery in 17 of them (35%)—but not one is mentioned in the newscast. Among them: 10 people (20%) suffered “a slight degree of temple hollowing”; two (4%) suffered intense temporary itching; one person (2%) had persistent forehead numbness one year later; one (2%) had “slight asymmetric eyebrow movement,” one (2%) had temporary hair loss or thinning, and one (2%) had persistent neck stiffness at one year.
The news story cites a study by its surgeon expert but, oddly, underplays both its strengths and weaknesses: it is a double-blind, sham-controlled, randomized trial comparing fake facelifts (incisions only) to real ones. (Plast Reconstr Surg 2009;124:461) The newscast leaves the viewer with the impression that the study is probably a case series with a much weaker design. And it fails to ask key questions, such as whether the diagnostic criteria (which rely on identifying trigger sites for migraine) are validated and reliable, or whether it is possible to truly blind people to a treatment that might alter their appearance. The diagnosis and treatment of migraine is extremely complex, and a report that glosses over its subtleties may mislead viewers.
The story appears to accurately represent the high prevalence of migraine in the U.S. when it says, “There are migraine sufferers in one out of every 4 households in this country.” According to the American Academy of Neurology, the prevalence is 18% among women and 6% among men. However, by focusing on a single person with intractable migraines, it fails to tell us anything about the natural course of headaches in the majority of migraine sufferers, or point out that migraines represent only a small fraction of all chronic headaches.
The sources for the newscast are just 2 people—a woman whose facelift successfully relieved her migraines and the surgeon who performs these procedures and wrote the study about facelifts for migraine headaches cited in the story (clearly not a disinterested party). The story fails to represent the points of view of the 43% of people who did not experience migraine pain relief after their facelifts or of experts who could place this research into the much broader context of the migraine literature.
The story fails to note that most mild-to-moderate attacks of migraine respond to simple analgesics, and most moderate-to-severe attacks can be treated with migraine-specific drugs (e.g. triptans). Other options include lifestyle changes (addressing potentially provoking factors such as sleep deprivation, stress, caffeine, smoking, diet, and alcohol) and nonpharmaceutical therapies (e.g. relaxation therapy, cognitive behavioral therapy, acupuncture, cervical manipulation, the herb feverfew, and the dietary supplements magnesium and vitamin B).
The story is not clear on how widely available this “treatment” is. It would appear to require the team efforts of a neurologist and plastic surgeon. The treatment is not mentioned in the American Academy of Neurology (AAN) 2007 evidence review and guideline on migraine headache (http://www.neurology.org/cgi/reprint/55/6/754.pdf).
The newscast suggests that this is a new treatment for migraine headache – referring to it as a "new migraine cure." However, published research on the treatment goes back nearly a decade. So it is neither new nor a cure.
We can’t be sure of the extent to which the segment may have relied on a news release. We do know that the story had only one expert voice – the study author – and no independent perspectives.