In a subgroup of patients, surgical trigger site deactivation may treat migraine effectively and relieve symptoms substantially, according to the results of a study published in the Annals of Surgery.
In this prospective study, Lisa Gfrerer, MD, PhD, of the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, and colleagues included patients who were evaluated for migraine surgery between January 2014 and January 2016.
All patients were diagnosed with migraine by at least one neurologist according to the International Classification of Headache Disorders, and all had refractory migraine. Patients completed a prospective migraine questionnaire preoperatively and at 3 and 12 months postoperatively. The study population consisted of 83 patients, 86% of whom were female.
The migraine headache index (MHI) improved significantly from baseline in a binary fashion. In 83% of patients, the MHI improved either ≥80% or ≤5%; MHI was in the intermediate range (5%-80%) in only 17% of patients. In 69% of patients, the improvement was ≥80%, with an average improvement of 96%. In 14% of patients, there was a ≤5% improvement, with an average improvement of 0%. In those in whom migraine headache improved ≥80%, migraine frequency, duration, pain, and MHI decreased significantly from baseline to follow-up.
The authors note that the finding of a strong binary distribution supports the argument that for a subgroup of patients, migraine may have a less complicated etiology and be cured with surgery. However, they emphasized that only patients with a clear clinical picture of migraine related to nerve compression are candidates for surgery.
The authors added that it is therefore essential to identify patients who have both an anatomic reason for pain and pain starting at the site of anatomic pathology.
The authors urge future research to further critically analyze the cause of extracranial contact point headaches and to improve outcomes by developing more accurate screening tools.
Gfrerer L, Hulsen JH, McLeod MD, Wright EJ, Austen WG Jr. Migraine surgery: an all or nothing phenomenon? Prospective evaluation of surgical outcomes [published online February 1, 2018]. Ann Surg. doi:10.1097/SLA.0000000000002697.