Peled, Ziv M. M.D.

Using a modified surgical technique, clinicians were able to help patients with chronic headaches experience a significant improvement. The procedure was originally designed for use in plastic surgery and targets specific nerves located in the temple, report US scientists in “Plastic and Reconstructive Surgery”.

The study, carried out by plastic surgeon Ziv M. Peled from San Francisco (California), included 19 people with chronic headaches that did not improve with medication. Preoperative tests with Botox or local anaesthetics to block the involved nerves had been successful. Before and after surgery, the severity of the headache was assessed using the Migraine Headache Index (MHI).

All participants were treated with the Gillies incision, a technique used in plastic surgery to repair cheekbones. Peled had found that the small incision on the temple behind the hairline provides direct access to the trigeminal nerve and the auriculotemporal nerve. This surgery aims either to relieve pressure from these nerves or to disconnect the nerves in order to prevent further headaches.

With this surgery, 16 of the 19 participants experienced at least a 50 per cent reduction in headache symptoms. The average MHI score decreased from 132 points before surgery to 52 points afterward. It remains unclear why the three remaining patients did not experience any improvement, said Peled.

Two of them had chronic headaches for several decades before surgery. In any case, there were no complications or major scars.


Previous studies had also provided good results and relief in headaches. But the surgical techniques used were more complex. The Gillies incision may present a simple approach that may reduce barriers for adopting this treatment, said Peled.

Personal comment: This is a brilliant example of how our understanding of chronic headache is insufficient, but that new “cutting edge” techniques do work.


Plastic & Reconstructive Surgery: May 2016 ­ Volume 137 ­ Issue 5 ­ p 1597–1600

doi: 10.1097/PRS.0000000000002051,  Reconstructive: Head and Neck: Ideas and Innovations