There is a growing body of medical literature indicating beneficial effect in migraine prophylaxis by paralyzing or decompressing certain pericranial muscles and nerves. This was initially an incidental finding following the use of Botulin toxin (BotoxR) injections to paralyze the corrugator supercilii muscles of the forehead for the long-term removal of frown-lines.

Botox is used to provide long-term paralysis (3 to 6 months) of selected muscles. Surgically ablating this muscle is a permanent alternative. Reduction in severity and frequency of migraines following such forehead rejuvenation procedures has been an unexpected finding, confirmed by both retrospective and prospective studies.

The reason for such outcomes is still being debated. The most popular hypothesis suggests that prolonged contraction of over-active corrugators lead to nerve compartment syndrome of the supratrochlear nerve, a branch of the trigeminal nerve. This in turn causes some degree of nerve ischaemia with consequent release of neuro-peptides from the nerve fibres causing neurogenic inflammation of the nerve and meninges.

The importance of the trigeminal nerve as a component of the pathogenic pathway for migraine headaches, has been studied for many years but its role in migraine genesis has not been identified until recently.

Some clinical researchers advocate surgical intervention for migraine prophylaxis, if the patients have a good response to Botox injections. We follow a strict case-selection protocol for these patients. They are assessed to exclude organic causes for the headaches; usually requiring a neurologist's consultation. The patients are then required to keep a log-book for one month prior to commencing treatment.