Medical Minute 8-8: Migraine Makeover

By: Vanessa Welch Email
By: Vanessa Welch Email

Susan Neuberger doesn't take any pain-free second on the job for granted. She suffered from migraine headaches for 33 years.

"It felt like somebody was stabbing me," said Neuberger.

It affected her career.

"I missed work at least once every two weeks…at least," said Susan Neuberger, Suffered Migraines.

Susan took medications for years, but never experienced relief. Then, she met Doctor Silvio Podda. He had read an article about a plastic surgeon who performed brow-lift surgery on 40 migraine patients.

"Out of those 40 patients, all of them who had done the procedure, they never had any more episodes of migraine," said Silvio Podda, M.D., Director, Birth Defects Center/Chief, Pediatric Plastic Surgery and Craniofacial Surgery St. Joseph's Regional Medical Center.

Doctor Podda suggested Susan try it since there are few risks to the common cosmetic procedure. First, Susan received Botox injections for a few months to temporarily paralyze muscles and nerves in her forehead. Then -- the procedure. Doctor Podda made two small incisions on the top of Susan's head and removed nerves and the glabella muscle -- the one that gives people their frown expression. That simple release reduces the pain. A study conducted by members of the American society of plastic surgeons found the brow-lift procedure completely eliminated migraines in 57-percent of patients. Doctor Podda says that's huge.

Susan says the day she went in for surgery changed her life.

"I have not had a migraine since that day. That was December 4th, 2009."

Now, she doesn't miss out on anything.

"When people say they were given a new lease on life, I really was, by Dr. Podda, and that was the best day of my life."

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500,


BACKGROUND: According to the Mayo Clinic, a migraine headache can cause intense throbbing or pulsing that is often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can cause pain that lasts for hours to days. Sometimes, sensory warning symptoms (aura) such as flashes of light, blind spots or tingling in the arms or legs can precede a migraine. These headaches often begin in childhood, adolescence or early adulthood. They are often under-diagnosed and untreated.

WHY DO THEY HAPPEN? Doctors don't know exactly what causes migraines, but they believe genetics and environment play a role. Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, which is a major pain pathway. Other factors like imbalances in brain chemicals, including serotonin, may also be involved. Serotonin levels fall during migraine attacks, and some believe this may trigger a person's trigeminal system to release substances called neuropeptides, which travel to the brain's outer covering. The result is headache pain.

TRIGGERS: There are many triggers for migraine. These may include:
• Hormonal changes: In women, fluctuations in estrogen seem to trigger headaches in those with known migraines. Women with a history of migraines often report headaches immediately before or during their menstrual cycles, when they have a drop in estrogen. Others tend to suffer from migraines during pregnancy or menopause.
• Foods: Common foods that may trigger a migraine include alcohol, aged cheeses, chocolate, aspartame, caffeine, monosodium glutamate, salty foods and processed foods.
• Stress: Stress at work or home can trigger migraines.
• Sensory stimuli: Bright lights and loud noises can trigger the headaches as well as unusual smells.
• Changes in sleep patterns: Missing sleep or getting too much sleep may be triggers for migraines.
• Environment: A change in weather or barometric pressure can prompt a migraine headache.
• Drugs: Certain medications can aggravate migraines.

PLASTIC SURGERY FOR MIGRAINES? Some doctors are using plastic surgery as a way to relieve the pain associated with migraine headaches. In one study, two neurologists and a member of the American Society of Plastic Surgeons investigated the effects of a brow lift procedure that included the removal of the migraine-triggering nerve areas. Of the 49 patients who had this procedure, 83 percent said that they were suffering from migraines half as frequently as they did before. More than half of the patients reported that their migraines had been completely eliminated.

Nancy Collins
Director, Public Relations/Marketing
St. Joseph's Healthcare System


Silvio Podda, MD, Director, Birth Defects Center and Chief, Pediatric Plastic Surgery and Craniofacial Surgery, St. Joseph’s Regional Medical Center, talks about a plastic surgery procedure that may help migraines.

How many people do you deal with when it comes to migraines? It seems like it is a huge problem.
Silvio Podda: It is a huge problem because the numbers are actually quite scary and I didn’t know about it before. There are like twenty eight or thirty million episodes of migraine every year. I think the calculation has been made at fourteen billion dollars are lost every year because people lose jobs. I don’t see that many right now because particularly in this area of the United States, in the northeast there are not that many guys that do it surgically. And the surgery of the migraine was a total coincident found. Meaning that there was a surgeon in Cleveland that was doing a lot of forehead rejuvenation, you know the brow lift surgery. And then he reviewed his old numbers and he realized that out of three hundred and fifty people that did this surgery there were forty that actually had migraines and they had complained of migraines. And out of those forty patients all of them that had done the procedure they never had any other episodes of migraines. So he started studying the problem. So you send the patient to a neurologist and the neurologist does the diagnosis. Once the diagnosis is made you have to follow a precise protocol. So you use Botox injection which I’m sure everybody is familiar. So you do the Botox injection to the muscle of the forehead, the muscle that gives you this kind of frowns, and every month you do the Botox injection. If the patient gets better you do it one month, the second month, the third month and if he passes four different trials that shows that the patient is a candidate for that type of surgery.
This is for people that start on Botox and they don’t want to take Botox the rest of their life?
Silvio Podda: They don’t want to take it, they stop. Because what happens with the Botox for that month after you actually have no migraine or much smaller migraine but then once you stop Botox the migraine comes back. And in general these operations are then for people that have chronic migraines and they suffer very, very often. So what you do after the patient has passed the protocol you need also to be evaluated by an ENT because sometimes it’s secondary to turbinate, to nose congestion or deviated septum. So once you’re sure that that’s the reason for the migraine then you can do the surgical release of the migraine which is actually a very simple surgery. You can do it again noninvasively with a camera so we do two small incisions covered by the hairline the same way we do the forehead lift. And then through the camera you go and then you remove the muscle that gives you the frown expression. Which are the muscles of the glabella, which is this area. Or you can do it doing a blepharoplasty which is an upper eyelid surgery. So you go underneath the eyebrow so you don’t see anything, you remove the muscles and that’s it. I’ve done a patient a year ago and Susan suffered horrific migraines. She’s the one actually that wrote me a letter, I mean I’ll do anything to let other people know because my life has completely changed. Because she has not had a single episode of migraines since then. And I mean I have never had migraines so I have no idea but when I see patients that have it’s a pretty debilitating injury and problem.
Are there any risks to this surgery?
Silvio Podda: Not really.
Other than infections?
Silvio Podda? Whenever you do a surgery that actually a lot of people do because medically you may imagine that the risks are basically a little bit of asymmetry of the eyebrow, you can damage one of the branches of the frontal nerve, you can have a little bit of asymmetry here from the forehead. But particularly in cases of patients that have migraines it seems a lot of patients accept those risks just to do it cosmetically that are actually very limited. And the more surgeries you do the better you get at it.

You must be logged in to post comments.

Password (case sensitive):
Remember Me:
WCTV 1801 Halstead Blvd. Tallahassee, FL 32309
Copyright © 2002-2016 - Designed by Gray Digital Media - Powered by Clickability 127265393 -
Gray Television, Inc.