Additionally, the frontalis and orbicularis oculi muscle function were never altered by surgery and, therefore, the patients in the treatment group did not have a completely motionless forehead. Meanwhile, sham surgery often resulted in some swelling and reduction in the muscle function temporarily, which was enough to give an impression of muscle removal to the patients with sham surgery. Regardless, the placebo effect in our sham surgery study was much more reliable than the Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) study where neither the patient nor the treating physician could miss the difference between those who received BT-A vs those who did not. To answer his question

about Alisertib whether the procedures were done JQ1 concentration unilaterally or bilaterally, none of the patients in this study had unilateral temporal or occipital headaches. However, since no muscle is removed to potentially cause asymmetry during the temple surgery and the removed muscle is insignificant

during the occipital surgery, the procedure is performed unilaterally on these two sites in rare patients with unilateral headaches. Dr. Mathew points out that we did not indicate whether preventative or abortive medications were altered, and he sees post-surgery patients who received BT-A and whose preventative medications were changed postoperatively thus altering the surgical results on patients to whom he attends. The preventative medications were not altered for our study patients except for those who had elimination and no longer needed migraine medications, as indicated

earlier, and none of the patients received BT-A injection after surgery while they were the subject of the study. Dr. Mathew outlines every adverse effect of the surgery and adds “Interestingly, only 2 of the adverse events were specifically cited to last for greater than 1 year, which would lead some readers to assume that the other events lasted for less than 1 year and resolved when in fact some of these adverse events may actually be ongoing.” over This kind of distortion of facts is a reflection of a prejudicial assessment of our studies. Any fair reviewer would have concluded that since we recorded and reported every complication throughout the follow-up period, if only two adverse effects were cited to be present at the 1-year follow up, that means the remaining complications were all temporary and resolved over time, which indeed was the reality. Dr. Mathew’s statement that I am attempting to discredit the trigeminovascular theory of MH is baseless. First, there is no such statement in any of our publications. I have advocated the role of peripheral mechanisms based on our findings and the efficacy of surgical procedures and BT-A, without dismissing any other theories. I do not believe that I am qualified to redefine the pathophysiology of the complex MH cascade. In the discussion paragraph, Dr.