Ptosis Repair Effective for Reducing Tension-Type Headache

Common cosmetic surgical procedures for reducing droopy eyelids were shown to improve quality of life in people with frequent tension-type headaches, according to a recent study by Ilke Bahceci Simsek, MD, of Yeditepe University in Istanbul, Turkey, published in JAMA Facial Plastic Surgery.¹ Headache Impact Test (HIT) scores obtained from 2 groups of patients undergoing blepharoplasty and eyelid ptosis repair indicated that both procedures provided significant relief from tension headache for up to 17 weeks post-surgery.

Ptosis repair is performed on the levitator muscle of the eyelid to tighten it and reposition the eyelid on the eye for unobstructed vision. Blepharoplasty, known cosmetically as an “eye lift,” removes excess skin and fat through an incision hidden in the natural eyelid crease. Both procedures have functional indications for impaired visual acuity, decreased peripheral vision, compensatory chin-up backwards head tilt, difficulty reading, eye strain, and fatigue.²

A previous study by Olson and Putterman³ observed that 30% of patients with ptosis were unable to read or work in a downgaze position for long periods, and frequently felt fatigue and/or brow-ache as a result, all of which were relieved by ptosis repair surgery.

For the current study, Dr Simsek recruited a total of 152 patients from the oculoplasty department of the ophthalmology clinic at Yeditepe University Medical School: 108 patients (66 men, 42 women; mean age, 49.8) who were scheduled to undergo bilateral blepharoplasty, and  44 patients (26 women, 18 men; mean age, 45.6) scheduled for eyelid ptosis repair surgery. Tension-type headache was diagnosed in 35.2% (n=38) of patients who underwent blepharoplasty (group 1) and 63.6% (n=28) of patients who underwent eyelid ptosis repair (group 2).

Both groups demonstrated significant improvement in HIT-6 scores post-surgically compared with preoperative levels: pre- and post-operative scores for group 1 were 55.9 (SD 6.6) vs 46.4 (SD 9.0) and 60.0 (SD 7.2) vs 42.3 (SD9.3) for group 2 (P =.001). “HIT score depends heavily on the patients and may be considered subjective, although it is an objective test,” Dr Simsek told Neurology Advisor.

Patients in group 2 had higher HIT-6 scores prior to surgery and lower scores post surgery compared with group 1, resulting in a more significant improvement in HIT-6 scores for group 2 (17.8 [SD 9.9] vs 9.5 [SD 8.6]; P =.002).

The findings support previous evidence from Matsuo, et al⁴ that ptosis repair provides greater benefit than blepharoplasty in improving HIT scores.

“This study has shown that repair of ptosis and upper eyelid dermatochalasis provides significant improvement in HIT scores for patients who have tension-type headache,” Dr Simsek concluded, adding that the evidence is sufficient to support expanding the indications for both surgeries. “This is a functional indication for ptosis repair and blepharoplasty; especially for the severe ptosis patients, correction of ptosis improves symptoms of chronic headache.”

References

1. Bahceci Simsek I. Association of upper eyelid ptosis repair and blepharoplasty with headache-related quality of life [published online March 2, 2017]. JAMA Facial Plast Surg. doi:10.1001/jamafacial.2016.2120
2. Cahill KV, Bradley EA, Meyer DR, et al. Functional indications for upper eyelid ptosis and blepharoplasty surgery: a report by the American Academy of Ophthalmology. Ophthalmology. 2011;118:2510-2517.
3. Olson JJ, Putterman A. Loss of vertical palpebral fissure height on downgaze in acquired blepharoptosis. Arch Ophthalmol. 1995;113:1293-1297.
4. Matsuo K, Ban R. Surgical desensitisation of the mechanoreceptors in Müller’s muscle relieves chronic tension-type headache caused by tonic reflexive contraction of the occipitofrontalis muscle in patients with aponeurotic blepharoptosis. J Plast Surg Hand Surg. 2013;4:21-29.