Melinda Brawn suffered from searing migraine headaches for more than 20 years.

She said she missed days of work and family functions and was forced to lie in bed for days in a quiet, dark room until the pain subsided.

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RELIEF FROM PAIN: Melinda Brawn suffered debilitating headaches until she underwent surgery recently. The 43-year-old Chelsea resident says she now no longer suffers from migraine headaches. Staff photo by Andy Molloy

Brawn, 43, of Chelsea said she tried everything imaginable — shots, patches, pills and more. But she said drugs gave her major stomach problems.

So her physician recommended surgery.

“They’re debilitating … they’re crippling,” Brawn said of her headaches. “But now I get up and face the day pain-free.”

David Branch, a Bangor hand and plastic surgeon, relieved Brawn’s pain using temporary injections of Botox, a widely used lifestyle drug used mostly to smooth wrinkled skin, to weaken the muscles impinging on nerves in Brawn’s head.

The injections were a temporary solution. Once she proved to be a good candidate for the surgery by responding well to the injections, he removed parts of muscles that impinge on those nerves.

Botox injections are expensive, between $250 and $800 a session, and people may need them for many, many years to preserve the pain relief, Branch said.

But surgery, he said, eliminates the problem “for good.”

“Patients who have had this surgery and no longer have migraines are simply the happiest patients I have ever seen,” he said. “People are busy and they don’t have time to be burdened with migraines. Well, now that burden has a chance to be eliminated.

“I typically inject people with Botox to see if they are candidates for the surgery. I’ve been doing the surgery for many years and it works very well.”

Brawn agreed.

“I would do it again tomorrow,” she said. “I was not able to function. I missed out on a lot of fun times with family because I was so sick, and now I’m not. I am so grateful to Dr. Branch and his staff for helping me get my life back.”

Common ailment, uncommon treatment

Migraine headaches affect 36 million people in the United States, according to the National Migraine Association. The ailment can cause intense throbbing in one area of the head, commonly accompanied by nausea, vomiting and hypersensitivity to light and sound. Symptoms can also include swallowing and breathing difficulties that, if extreme, can be life-threatening.

Russell Katz, director of the U.S. Food and Drug Administration’s Division of Neurology Products, said chronic migraines are one of the most disabling forms of headache. Patients with chronic migraines experience a headache more than 14 days a month, he said.

“This condition can greatly affect family, work and social life, so it is important to have a variety of effective treatment options available,” Katz said.

Branch said migraines are a neurological disease associated with changes in the size of arteries inside and outside the brain.

He said the likely cause of a migraine headache occurs when muscles surrounding the nerves become tense or irritated, causing the nerve branches, or “trigger zones,” to become more excitable.

Branch said he discovered the benefits of botox therapy for migraines studying under Bahman Guyuron, chairman of plastic and reconstructive surgery at Case Western Reserve University School of Medicine in Cleveland, who discovered the outpatient procedure.

In a double-blind study conducted last year, Guyuron found 80 percent of patients who had migraine surgery using Botox in one of three “trigger zones” significantly reduced the number of headaches.

More than half of the patients reported a elimination of headaches altogether.

Dangerous toxin

The botulinum toxin is considered one of the most powerful neurotoxins ever discovered.

But in 2002, the FDA approved an application from a company called Allergan to create Botox for various cosmetic procedures, including treatment for wrinkles.

Allergan says Botox went on to become the second-most recognized prescription drug brand in the world, behind only Viagra. In 2007, Botox sales were $1.2 billion.

Then, last year, the FDA approved Botox for the treatment of chronic migraine headaches in adults.

The FDA says Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves. The effects last about three to four months.

Side effects can include pain at the injection site, flu-like symptoms, headache and upset stomach. Injections in the face may also cause temporary drooping eyelids. Women should not use Botox if they are pregnant or breast-feeding.

Sandy Walsh of the FDA said Botox and Botox Cosmetic carry warning labels saying the effects of botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism.

But Walsh said there has not been a confirmed serious case in which toxin spread after the recommended dose had been used to treat chronic migraines.

The injections are a necessary precursor to the surgery, which includes incisions to many parts of the head.

As with any surgery, there are potential complications. The American Society of Plastic Surgeons said the risk with surgery to the forehead include unfavorable scarring, bleeding, infection, blood clots, facial nerve injury, numbness and intense itching.

Still, Gordon Smith, executive vice president of the Maine Medical Association, said he hasn’t received any complaints about the procedure.

“Branch is a member of the association and I’ve heard about the procedure,” Smith said. “I know he’s had some success with it.”

Added Branch: “There’s a real movement afoot with the cooperation between surgeons and neurologists. I think people are gradually getting more and more on board with sending their worst patients to us who are leaving headache-free.”

Under the knife

Lori Welch, Branch’s migraine patient coordinator, said the first step is to determine the location of the sensory nerves triggering a person’s migraines, either in the forehead, nose, temples or back of the head.

Then the doctor injects Botox, which temporarily paralyzes the muscle impinging on those nerves.

“Once the patient leaves that day, we give them a journal and they keep track of their migraine activity,” Welch said. “If (Botox is injected in) all four zones, most likely their migraine will go away, there’s nothing impinging on those nerves anymore.”

If the migraine moves to a different area, that’s when Branchhen recommends surgery. She said Branch removes part of the muscle impinging on the nerve. Then he grafts a little bit of fat around the nerve as a cushion so it can’t trigger any more migraines.

She said it takes a week or two to recover from the surgery.

Brawn said she had the Botox injections in February and the seven-and-a-half hour surgery in April.

She said three-inch cuts were made on each side of her temple, across her eyelids, across her nose and on the back of her head.

Every part of her head was sore after the procedure, and she said she had to wrap towels around her neck and head for support on her pillow.

“It was worth the surgery,” she said. “I feel great.”

Getting her insurance company to pay for the procedure has been another matter.

“The insurance company has been a battle,” Brawn said. “They paid for the Botox after I fought with them and proved the FDA approved it. But now I’m fighting with them to pay for the surgery, which was $8,500.”

Dawn Lewis, of Hartland, had a procedure done in May 2009.

Lewis’ migraines had forced her into several trips to the emergency room because of vomiting and dehydration associated with her condition.

She tried all the medications; made visits to orthodontists, chiropractors and massage therapists; and even tried experimental therapies, such as electric stimulation of her skull.

Lewis, who said she was burdened with migraines weeks on end, said she thinks insurance companies are coming around to the idea of Botox injections and migraine surgery.

“They had records of all of the things I’ve tried over the years,” Lewis said. “They knew it wasn’t a spur-of-the-moment thing. I had great documentation so I was accepted and went in and had the surgery.

“Was it painful? Yes. Was it worth it? One hundred and fifty percent, yes,” Lewis said. “I haven’t had a migraine for two years.”

Mechele Cooper — 621-5663

mcooper@centralmaine.com

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