Surgery for migraine

Guyuron B, Lineberry K, Nahabet EH. A retrospective review of the outcomes of
migraine surgery in the adolescent population. Plast Reconstr Surg. 2015
Jun;135(6):1700-5.

Abstract

BACKGROUND:

Migraine surgery has been studied extensively in adult patients with refractory headaches. The purpose of this study was to review a single surgeon's outcomes following migraine surgery in an adolescent population.

METHODS:

A retrospective review of all patients operated on by the senior author (B.G.) from 2000 to 2014 was performed. All patients aged 18 years or younger with at least 1 year of follow-up after surgery were included. Preoperative and postoperative migraine frequency, duration, severity, and migraine headache days and migraine index were analyzed for statistical significance.

RESULTS:

A total of 14 patients and 15 operations were analyzed. After an average follow-up of 38.2 months, the frequency of migraine headaches per 30-day period was reduced from 25 to 5 (p < 0.0001), the migraine headache index decreased from 148.1 to 12.4 (p < 0.0001), the duration of headaches (number of hours per 24 hours) declined from 0.71 to 0.25 (p = 0.002), severity of headaches diminished from 8.2 to 4.3 (p = 0.0004), and migraine days per month declined from 25 to 5 (p < 0.0001). Five patients remained free of any symptoms following surgery. One patient had no improvement in frequency of headaches, but did have improvement in severity and duration of headaches. No postoperative complications were noted in this group of patients.

CONCLUSION:

In the adolescent population with migraine headaches refractory to traditional medical management, migraine surgery may offer symptomatic improvement of migraine headache frequency, duration, and severity in patients with identifiable anatomical trigger sites.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
 

Guyuron B, Harvey D, Reed D. A Prospective Randomized Outcomes Comparison of
Two Temple Migraine Trigger Site Deactivation Techniques. Plast Reconstr Surg.
2015 Jul;136(1):159-65.

Abstract

BACKGROUND:

The authors compared the reduction of migraine headache frequency, days, severity, and duration after surgical decompression versus avulsion of the zygomaticotemporal branch of the trigeminal nerve for treatment of temporal migraine headache.

METHODS:

Twenty patients with bilateral temporal migraine headache were randomized to undergo avulsion of the zygomaticotemporal branch of the trigeminal nerve on one side and decompression via fasciotomy and removal of the zygomaticotemporal artery on the other side. Results were analyzed after a minimum of 12 months of follow-up.

RESULTS:

Nineteen patients completed the study. The patients experienced greater than 50 percent improvement in frequency, migraine days, severity, and duration in 34 of the 38 operative sites (89 percent). Complete elimination of symptoms was noted in 21 of the 38 operative sites (55 percent). In the decompression group, migraine frequency was reduced from 14.6 to 2.2 per month, migraine days from 14.1 to 2.3, severity from 7.0 to 2.9, duration from 9.6 to 4.8 hours, and Migraine Headache Index score from 42 to 2.9. In the neurectomy group, frequency decreased from 14.2 to 1.9 per month, migraine days from 14.1 to 2.3, severity from 6.8 to 2.6, migraine duration from 10.1 to 5.3 hours, and the Migraine Headache Index score from 41 to 2.5. There was no statistical significance in reduced migraine headache frequency, days, severity, and duration between the two groups.

CONCLUSIONS:

Neurectomy and decompression of the zygomaticotemporal branch of the trigeminal nerve are both appropriate treatment for temporal migraine headache. If decompression fails to provide sufficient relief, neurectomy is another option.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.

Courtesy of a colleague