Surgery For Long-Term Temporal Headaches: Simplified Methodology Shows Great Results

02A revised operative approach may provide a simpler method of the medical procedures for one kind of chronic pain, according to a “Ideas and Improvements” newspaper in the May problem of Vinyl and Reconstructive Surgery(R), the state medical journal of the North american Society of Clear plastic Surgeons (ASPS).

Using an incision formerly made for another purpose, cosmetic surgeons can gain immediate access to the nerves involved with some types of serious temporal headache, in line with the survey by ASPS Member Physician Dr. Ziv M. Peled of Peled COSMETIC SURGERY, SAN FRANCISCO BAY AREA. He expects his new approach will “lower the pub to adoption” of effective medical procedures for patients with this debilitating throbbing headache condition.

Efficient Method of Surgery for Chronic Temporal Headache

03Lately, surgery has surfaced as an efficient treatment option for decided on patients with persistent, severe headaches. Produced by plastic cosmetic surgeons who pointed out that some migraine patients acquired fewer head pain after aesthetic forehead-lift, these methods address “cause sites” associated with certain headache habits.

Severe temporal head pain can derive from muscle spasms or enlarged arteries adding pressure on specific nerves on the area of the head–specifically, the zygomaticotemporal branch of the trigeminal nerve (ZTBTN) and sometimes the auriculotemporal nerve (ATN). Of these operative procedures, cosmetic surgeons seek to alleviate pressure on these nerves or even to detach the nerves to be able to avoid them from triggering future problems.


The strategy is a fresh use of a strategy that many doctors are already acquainted with: the Gillies incision, used for medical repair of cheekbone fractures. Dr. Peled discovered that this brief incision, put in the temple behind the hairline, provides immediate access to the ZTBTN and ATN. He describes his initial experience with the new approach in 19 patients.

05All patients experienced chronic temporal head pain that didn’t improve with medications. In addition they acquired a positive consequence on preoperative testing–either treatment of botulinum toxin (Botox) to briefly obstruct muscle activity, or local anesthetics to obstruct the included nerve briefly. Before and after surgery, headache symptoms were assessed by using a standard score, the Migraine Headache Index (MHI).

As in prior studies, surgery provided significant rest from chronic temporal head pain. Average MHI credit score lowered from about 132 details before surgery to 52 details afterward. On the 19 patients, 16 acquired at least a 50 percent decrease in headache symptoms.

It’s unclear why the three left over patients didn’t have good improvement, although Dr. Peled records that two of the three possessed had temporal head aches for many years before surgery. Nothing of the patients experienced problems, and there is little if any noticeable scarring.

07The experience helps an evergrowing body of research demonstrating good benefits with surgery for chronic temporal head aches. Most recently, a report in Vinyl & Reconstructive Surgery reported similar results if the nerve is disconnected or decompressed. However, earlier studies have used more technical methods to gain access to the ZTBTN theoretically.

The simplified procedure using the Gillies incision combines the features of other methods to chronic temporal frustration surgery while lessening the negatives, Dr. Peled thinks. He reviews, “That is a straightforward approach and effective method that could make it easier for vinyl surgeons to look at and offer operative options for patients with this incapacitating condition.”