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McNemar Cosmetic Surgery Thomas B. McNemar, MD, FACS

Botox helps doctor relieve migraines

DHM physician combines it with 'trigger point' surgery

From The Manteca Bulletin, by Glenn Kahl March 11, 2010

Migraine Relief with BOTOX® Cosmetic and facial surgery
Dr. McNemar treats migraines with brow lift.

There's a definite excitement in the air at Doctors Hospital of Manteca as one of its physicians, Dr. Thomas B. McNemar, M.D. is offering migraine headache relief through Botox injections and sequential facial surgery.

"The beauty of this whole thing is that it doesn't require anything radical," he said.

Maryann Niese of Tracy has suffered from severe migraine headaches for the past 20 years that kept her secluded in her home and away from any bright daylight. "It was a miracle," she said of the Botox treatment followed later with surgery in January after first seeing three neurologists for help.

The Botox injections are only good for three months, but the surgical procedure to neutralize the trigger point nerves is good indefinitely in many patients, McNemar said.

Niese said the light hurt her eyes so badly that she didn't want to get out of bed. She said that she was made aware of the procedures by her sister living in Ohio who saw a television segment detailing the operation at a Cleveland clinic. That surgery was performed on the wife of the TV station anchor.

She said migraines run in her family – her aunt and her younger sister both suffering from severe headaches that incapacitated them. "I remember my mom saying she had sick headaches," of her illness.

She said she sought out Dr. McNemar finding he had studied with the same doctors behind the TV segment – the only one she could find willing to work with her surgically rather than prescribing pills as a solution.

She tried various things including 5 different drugs

Grandmother of two small children, she said she has tried five different drugs, Beta blockers, and pills for her headaches and for her related depression, finding only short-term relief. She said that first miracle was the reaction she had to a Botox injection on November 9 of last year.

Not only did it actually relieve her headaches for the first time in two decades, it removed the frown wrinkles in her forehead, she chuckled. Niese added that the Botox was not an immediate next day relief, but that the chronic irrigation of the peripheral nerves came over several weeks.

"I can enjoy my grandkids now – getting out and playing with them. I can go outside and look at the sky where before I had lived in the dark," she said. Niese said she is happy and her husband is happy with her new-found relief from those debilitating headaches.

Dr. McNemer said the Botox usually lasts for only three months depending where the trigger point nerves are located that tie into muscles often located behind the eyes. . They could be at the temple areas, the forehead or the neck. He depends on his patients to lead him to those most sensitive points, he said. Niese had her surgery before her Botox injections wore off, she noted.

Some 90 per cent of patients have found a reduction in their headache pain, McNemer said. "There is a lot of upside," he said. "The biggest risk fear is finding that it didn't work." McNemer said the procedure is comparable to facial plastic surgery.

"At this point very few insurance companies are recognizing the procedure and few other physicians are showing interest," he added. There is reluctance for people to understand the process, he added. Many doctors at this point feel it's all about medication – medication that is currently a billion dollar business.

McNemer pointed out that many sufferers can spend up to $7,000 a year for relief with pills and miss days at work. The actual surgery costs only a few hundred dollars more than that figure. "If the Botox works, there is a high percentage where the surgery will also work," he said.

The insurance companies may start to take notice when the contrasting costs of medication over surgery become more obvious to them, he added.

The procedure had its birth at the University Hospitals Case Medical Center in Cleveland, Ohio after plastic surgery department chair Dr. Bahman Guyuron took a year off to do his own research at this own expense to find a migraine cure.

61 of 79 benefitted long term from procedures

Through double blind tests he determined that surgery to remove the trigger points for migraines does lead to dramatic improvement in patients' health. Researchers from University Hospital in Cleveland reported their findings at a meeting of the American Society of Plastic Surgeons in Seattle last October.

Dr. Guyron and his colleagues performed surgery on 79 migraine sufferers whose conditions they followed for five years.

Ten of the patients required additional surgeries and were removed from the analysis. Sixty-one of the remaining 69 patients maintained their positive responses to the procedure for the full five years.

Twenty patients reported elimination of the migraines entirely with 41 reporting a significant decrease in symptoms and in frequency. Eight showed less that a 50 per cent improvement.

For patients with frontal migraines, Guyuron removed the corrugators supercilii – frowning muscle group in the forehead – which is thought to compress nerves and produce inflammation. For temple migraines, doctors remove a small branch of the trigeminal nerve. For headaches that are behind the eye and triggered by weather changes, work is performed on the nose septum and surrounding structures.

While Dr. McNemer is on staff at Doctors Hospital of Manteca, his office is located on Grantline Road in Tracy.

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