"A modified surgical technique may provide a simpler approach to the surgical treatment for one type of chronic headache according to an Ideas and Innovations paper in the May issue of Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg the official medical journal of the American Society of Plastic Surgeons http ASPS.  Using an incision originally designed for another purpose surgeons can gain direct access to the nerves involved in some types of chronic temporal headache according to the report by ASPS Member Surgeon Dr. Ziv M. Peled of Peled Plastic Surgery San Francisco. He hopes his new technique will lower the bar to adoption of effective surgical treatment for patients with this debilitating headache condition. Efficient Approach to Surgery for Chronic Temporal Headache  In recent years surgery has emerged as an effective treatment option for selected patients with chronic severe headaches. Developed by plastic surgeons who noticed that some migraine patients had fewer headaches after cosmetic foreheadlift http these procedures address trigger sites linked to certain headache patterns. Severe temporal headaches can result from muscle spasms or enlarged blood vessels putting pressure on specific nerves located on the side of the headspecifically the zygomaticotemporal branch of the trigeminal nerve ZTBTN and sometimes the auriculotemporal nerve ATN. During these operative procedures surgeons seek to relieve pressure on these nerves or to disconnect the nerves in order to prevent them from triggering future headaches. The technique is a new use of an approach that many surgeons are already familiar with the Gillies incision used for surgical repair of cheekbone fractures. Dr. Peled found that this short incision placed in the temple behind the hairline provides direct access to the ZTBTN and ATN. He describes his initial experience with the new approach in  patients. All patients had chronic temporal headaches that did not improve with medications. They also had a positive result on preoperative testingeither injection of botulinum toxin Botox to temporarily block muscle activity or local anesthetics to temporarily block the involved nerve. Before and after surgery headache symptoms were assessed using a standard score the Migraine Headache Index MHI. As in previous studies surgery provided significant relief from chronic temporal headaches. Average MHI score decreased from about  points before surgery to  points afterward. Of the  patients  had at least a  percent reduction in headache symptoms. Its unclear why the three remaining patients didnt have good improvement although Dr. Peled notes that two of the three had had temporal headaches for decades before surgery. None of the patients experienced complications and there was little or no visible scarring. The experience supports a growing body of research showing good outcomes with surgery for chronic temporal headaches. Most recently a study in Plastic  Reconstructive Surgery reported similar results whether the nerve is decompressed or disconnected http However previous studies have used technically more complex approaches to access the ZTBTN. The simplified approach using the Gillies incision combines the advantages of other approaches to chronic temporal headache surgery while minimizing the disadvantages Dr. Peled believes. He comments This is a straightforward technique and effective procedure that may make it easier for plastic surgeons to adopt and offer surgical options for patients with this debilitating condition.  Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg is published by Wolters Kluwer http Click here to read A Novel Surgical Approach to Chronic Temporal Headaches. httpjournals.lww.complasreconsurgAbstractA_Novel_Surgical_Approach_to_Chronic_Temporal..aspx  Article A Novel Surgical Approach to Chronic Temporal Headaches doi .PRS.  About Plastic and Reconstructive Surgery  For more than  years Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons Plastic and Reconstructive Surgery brings subscribers uptotheminute reports on the latest techniques and followup for all areas of plastic and reconstructive surgery including breast reconstruction experimental studies maxillofacial reconstruction hand and microsurgery burn repair and cosmetic surgery as well as news on medicolegal issues.  About ASPS  The American Society of Plastic Surgeons ASPS is the worlds largest organization of boardcertified plastic surgeons. Representing more than  Member Surgeons the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than  percent of all boardcertified plastic surgeons in the United States. Founded in  the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. 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