Does a brow lift help with migraines?

Question

I know the botox does and it is something that has to be repeated every 12 weeks or so. I have had it done once but only in the forehead area which since I chose to have a cosmetic doctor do it my insurance wouldn't cover it. However the insurance wanted me to have it done in my neck also and I was terrified of that because i have some pretty bad neck issues. I have heard that brow lift does help and is more permanent. I have such severe migraines that I would be willing to self finance

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for the good question. You are correct that migraine sufferers can find some relief with Botox injections. These have to be repeated or the migraines return. It does seem that some patients who have migraine headaches do experience relief with brow lifts. It is not clear how often this procedure works to diminish the pain or frequency of headaches. I would have an evaluation with a neurologist as well as an oculoplastic surgeon who can assess your problem and create a tailored treatment plan for you. I hope you find this helpful.

Philip S. Schoenfeld, MD, FACS · Answer

You have asked an excellent question and one that is being written about and debated every day.  It is somewhat of a complicated answer but I will try to simplify it.  If you have a diagnosis of migraine headaches and if your trigger point is due to pressure on the nerves in the temple or glabella area of your forehead you may find that a browlift with decompression of the sensory nerves in the temple and glabella region will be of help.  Botox can be used to see if there is a reduction in your migraines but success with Botox is not an absolute guarantee that a browlift will duplicate the effects.  Failure of Botox would however, make me a bit wary that surgery would be of benefit to relieve your migraines.

Zoran Potparic, MD · Answer

First you have to have a right diagnosis of migraine source. This can start with botox injection. If you observe that after injection of  botox in forehead area your migraines are less frequent and shorter in duration the cause (trigger point) may be in forehead nerves. There are at least 2-3 locations in forehead and around orbits where nerve can be pinched by muscle, bone, ligament or blood vessel which will create constant irritation and trigger a pain which then spreads over large area. There are number of trigger spots around the skull and upper neck. Careful evaluation of these trigger points by an experienced neurologist or plastic surgeon (there are quite a few which are excellent) may lead to right diagnosis. Elective surgery by means of pressure release (nerve decompression) may result in significant clinical improvement.To answer your question, brow lift as a way to approach and release pinched nerve(s) may be used to treat migraine in selected patient. Good luck.

A. Joshua Zimm, MD · Answer

It may.  There was a good study done a few years ago that suggested it could help in refractory migraine cases.  Nonetheless, without other corroborating studies, it's hard to make this claim with any degree of certainty.  Best of luck.

Robert Oliver Jr., MD · Answer

The answer to this is kind of controversial. A brow lift itself does not really have an effect. What has been suggested to improve people with a migraine "trigger" in the central brow areas is dividing the corregator muscle (a maneuver not always done in a brow lift actually) which can pinch or impinge on one of the sensory nerves in the area. Treating the central brow with Botox has been suggested as a good proxy for patients who might see improvement with division of that muscle and freeing up the associated nerve. As has been mentioned, there are also several other trigger points in the temple and neck which have also been suggested to be associated with this phenomena.Many neurologists who treat migraines are somewhat skeptical that this is actually a common phenomena, but it clearly can help some people with anatomical variants where these small nerves are entrapped and irritated. Confusing the issue is the phenomena that Botox can suppress pain stimuli, and the effect of the relief you got from injections was really due to that affect on the nerve rather then paralyzing the muscle group. That could explain the failure of the surgery in some patients that improved with botox prior.

Does a brow lift help with migraines?

Answers (5)

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