People who suffer from chronic migraines could benefit from surgery, it has been suggested.
Doctors in the United States say removing key muscles in the forehead and neck of patients who get severe headaches can stop the pain.
They carried out operations on 100 patients a year ago. Of these, 90 now say they have far fewer migraines or none at all.
The cause of migraines which affects one in 10 people is unknown.
Pinched nerves
The decision to operate on migraine sufferers was based on a theory the headaches occur, in many cases, when nerves are trapped or pinched by certain muscles.
Dr Bahman Guyuron, who is based at the Zeeba Clinic in Cleveland, Ohio, developed this theory after injecting some of his patients with botox.
"
It seems to be on the face of it fairly radical but I don't think it should be dismissed
"
Dr Andrew Dowson,
Migraine Action Association
Botox is used for cosmetic purposes to reduce wrinkles and lines around the face by temporarily paralysing the muscle underneath the skin.
Two patients who suffered regularly from migraines told Dr Guyuron they had experienced fewer headaches since having the botox injection.
He identified 314 people who had received a botox injection.
Of these, 39 said they had regularly suffered from migraines. However, 31 people said their headaches stopped after the injection.
Last year, Dr Guyuron launched a small scale trial to test the theory further. Each of the 100 volunteers suffered from 15 migraines each month, on average.
Dr Guyuron believes migraines occur because of problems in one of four areas of the head - the forehead, the temple, the back of the neck or the nose.
In some instances, it can be caused by problems in more than one of these areas, he said.
He used botox to paralyse muscles in each of these areas, excluding the nose, one at a time over three months.
After each injection, patients were asked if they were still getting migraines.
If they were still getting headaches, Dr Guyuron deduced the source was in the nose.
Undergo surgery
These patients then had surgery to straighten the bone in their nose that separates the nostrils.
The other patients had surgery to remove the muscle, which had been temporarily paralysed by botox.
One year on, Dr Guyuron says the vast majority of patients have reported improvements.
"Preliminary results show that we are getting about a 90% response rate," he told BBC News Online.
"These patients have seen at least a 50% reduction in the severity of migraines. Some had no migraines at all now."
Dr Guyuron is confident the changes will last.
"The effects of botox are only temporary. We are hoping that surgery will be more long-lasting and may even be permanent."
The findings were presented at the World Congress of Plastic Surgery in Sydney, Australia.
'Fairly radical'
Dr Andrew Dowson, medical advisor to the Migraine Action Association, described the findings as interesting.
"It seems to be on the face of it fairly radical but I don't think it should be dismissed.
"If anything works in more than two thirds of patients you have to think you may be on to something," he told BBC News Online.
Dr Dowson is involved in a trial to see if botox by itself is effective.
"For some people, it doesn't seem to have any effect. But it does appear to work for some people.
"We are hoping to have definitive results within a year."
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