Abstract
Chronic daily headache (CDH) located in the frontal region is a common problem. We have previously described the positive results that were achieved with botulinum toxin (BTX) injections in the musculus corrugator supercilii (MCS) for this disorder. Nowadays, we offer transection of this muscle to patients following a minimum of two BTX injections, provided these injections result in a significant reduction of pain. This procedure is based on the assumption that the pathophysiological mechanism in some of these patients suffering from CDH is a neural entrapment of the supratrochlear nerve in the corrugator muscle. To assess the effect of transection, we have evaluated all the consecutive patients (n = 10) so far. Treatment was successful in nine of these patients. Prior to the treatment, the mean pain score in the 9 successfully treated patients was 8.1 (range 6–9), after transection this had been reduced to 0.8 (range 0–3). All of these successfully treated patients ceased their daily use of pain relief medication for their frontally localised headaches. Moreover, they stated that they would definitely undergo surgery, if they were to find themselves in the same situation again. Therefore, we conclude that transection of the MCS is an efficient and successful procedure for a carefully selected group of patients suffering from CDH in the frontal region. Most of all we intend to popularise this pathophysiological concept based on the distinct possibility that some headaches might be due to neural entrapment.
Similar content being viewed by others
References
Bearden WH, Anderson RL (2005) Corrugator superciliaris muscle excision for tension and migraine headaches. Opthal Plast Reconstr Surg 21:418–422
De Ru JA, Buwalda J (2009) Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache. J Laryngol Otol 123:412–417
Dirnberger F, Becker K (2004) Surgical treatment of migraine headaches by corrugator muscle resection. Plast Reconstr Surg 114:652–657
Dodick DW, Mauskop A, Elkind AH, DeGrijse R, Brin MF, Silberstein SD (2005) Botulinum toxin type A for the prophylaxis of chronic daily headache: subgroup analysis of patients not receiving other prophylactic medications: a randomized double-blind, placebo-controlled study. Headache 45:315–324
Evers S, Olesen J (2006) Botulinum toxin in headache treatment: the end of the road? Cephalalgia 26:769–771
Glasziou P, Chalmers I, Rawlins M, McCulloch P (2007) When are randomised trials unnecessary? picking signal from noise. BMJ 334:349–351
Guyuron B, Varghai A, Michelow BJ, Thomas T, Davis J (2000) Corrugator supercilii muscle resection and migraine headaches. Plast Reconstr Surg 106:436–437
Guyuron B, Tucker T, Davis J (2002) Surgical treatment of migraine headaches. Plast Reconstr Surg 109:2183–2189
Janis J, Ghavami A, Lemmon J, Leedy JE, Guyuron B (2008) The anatomy of the corrugator supercilii muscle: part II. Supraorbital nerve branching patterns. Plast Reconstr Surg 121:233–240
Mathew NT, Kailasam J, Meadors L (2008) Predictors of response to botulinum toxin type a (BoNTA) in chronic daily headache. Headache 48:194–200
Rawlins M (2008) De testimonio: on the evidence for decisions about the use of therapeutic interventions. Lancet 372:2152–2161
Roach ES (2008) Questioning botulinum toxin for headache. Arch Neurol 65:151–152
Silberstein SD (2005) Chronic Daily Headache. JAOA 105:23–29
Silberstein SD, Stark SR, Lucas SM, Christie SN, DeGrijse RE, Turkel CC (2005) Botulinum toxin type A for the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc 80:1126–1137
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
de Ru, J.A., Schellekens, P.P.A. & Lohuis, P.J.F.M. Corrugator supercilii transection for headache emanating from the frontal region: a clinical evaluation of ten patients. J Neural Transm 118, 1571–1574 (2011). https://doi.org/10.1007/s00702-011-0654-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00702-011-0654-1