Hollowed temples, he said, "would be upsetting to a patient, and it can take many months for it to go away."
Ivan S. Login, a migraine expert and professor of neurology at the University of Virginia, said he wasn't sure Guyuron's patients had migraines or a different type of headache caused by sinus or other problems. He also said that the success rate seemed unusually high.
If Botox relieves migraines, surgery may be next.
(Dynamic Graphics/PictureQuest Image)
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"Until these results are replicated, it's hard to know how much validity to put on this data," said Login.
Stephen Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, agreed. One concern, he said, is Guyuron's reliance on Botox, which has been shown to have a high placebo response. About 40 percent of patients in some studies did as well after being injected with a dummy liquid as with Botox, one reason the Food and Drug Administration has not approved the wrinkle smoother as a migraine treatment, according to neurologists.
"What I'm concerned about is that migraine patients are desperate, and some of them will grasp onto this," said neurologist Merle Diamond, associate director of the Diamond Headache Clinic in Chicago. "I certainly wouldn't want to have people rushing off to get their muscles cut."
Jennifer S. Kriegler, a neurologist and co-author of the January study, said that she diagnosed patients. All had migraines according to the standard medical definition.
"I will tell you I was as skeptical as anyone," she said. "To me the biggest issue is going to be long-term follow-up."
Surgery, she said, is not a first-line treatment. "These are people who have failed everything" or who cannot take triptans.
Cost is a major drawback, Stark noted, because insurance companies would consider the surgery, for which Guyuron charges $4,000 per site, cosmetic and ineligible for reimbursement, just as they do with Botox treatments for migraines. Most patients, according to Guyuron, need surgery on at least two sites.
He views the issue in a different light. Patients who undergo surgery, which he has taught to several plastic surgeons around the country, would save money they now spend on drugs and avoid the side effects of medications.
"The majority," he added, "would benefit from the aesthetic changes they would experience."•
