Comprehensive Surgical Treatment of Migraine Headaches

Guyuron, Bahman; Kriegler, Jennifer S.; Davis, J. Kelly; Amini, Saeid B.

doi:10.1097/01.prs.0000145631.20901.84

Cited by 188 publications

(112 citation statements)

References 28 publications

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“…3,4 Seventy-nine percent of the patients included in this study experienced an improvement of 50% or greater in MHI, which is consistent with the literature. 4,8 Furthermore, we observed a significant decrease in headache frequency and intensity, with duration also trending downward, which again remains consistent with the literature. Also, the relatively binary distribution of patient improvement observed in our data, with approximately 70% of participants either experiencing greater than 80% improvement or less than 5% improvement, is similar yet less extreme than the distribution described by Gfrerer et al and may further support the anatomical nature of extracranial migraine trigger sites.…”

Section: Discussionsupporting

confidence: 91%

Measuring success in headache surgery: A comparison of different outcomes measures.

Albano

Israel

Carbullido

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Studies of migraine surgery have relied on quantitative, patient-reported measures like the Migraine Headache Index (MHI) and validated surveys to study the outcomes and impact of headache surgery. It is unclear whether a single metric or a combination of outcomes assessments is best suited to do so. Methods: All patients who underwent headache surgery had an MHI calculated and completed the Headache Impact Test, the Migraine Disability Assessment Test, the Migraine-Specific Quality-of-Life Questionnaire, and an institutional ad hoc survey preoperatively and postoperatively. Results: Twenty-seven patients (79%) experienced greater than or equal to 50% MHI reduction. MHI decreased significantly from a median of 210 preoperatively to 12.5 postoperatively (85%; P < 0.0001). Headache Impact Test scores improved from 67 to 61 (14%; P < 0.0001). Migraine Disability Assessment Test scores improved from 57 to 20 (67%; P = 0.0022). The Migraine-Specific Quality-of-Life Questionnaire demonstrated improvement in quality-of-life scores within all three of its domains (P < 0.0001). The authors’ ad hoc survey demonstrated that participants “strongly agreed” that (1) surgery helped their symptoms, (2) they would choose surgery again, and (3) they would recommend headache surgery to others. Conclusions: Regardless of how one measures it, headache surgery is effective. The authors demonstrate that surgery significantly improves patients’ quality of life and decreases the effect of headaches on patients’ functioning, but headaches can still be present to a substantial degree. The extent of improvement in migraine burden and quality of life in these patients may exceed the amount of improvement demonstrated by current measures.

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Section: Discussionsupporting

confidence: 91%

Measuring success in headache surgery: A comparison of different outcomes measures.

Albano

Israel

Carbullido

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Site I is a common operative site for migraine surgery 50 performed in 57% of the migraine surgery patients of Gfrerer et al 10 Both endoscopic and open techniques have been described to decompress the supratrochlear and supraorbital nerve branches of the ophthalmic division of the trigeminal nerve. 55 In a 2012 retrospective matched analysis of a Guyuron cohort by Chepla et al 42 patients who underwent foraminectomy with depressor supercilii and corrugator myectomy were found to have statistically significant superior improvements in forehead pain ( P < .05), forehead frequency ( P < .05), and MHI ( P < .01) compared myectomy alone.…”

Section: Discussionmentioning

confidence: 99%

“…51,52 In a 2009 RCT by Guyuron et al 27 a semispinalis capitis myectomy and subcutaneous flap procedure to protect the nerve were superior to nerve exposure alone. Most studies have reported using Guyuron's surgical method to Site IV surgery, 27,30,50,[52][53][54] which has been previously described, 55 although GON excision or neurolysis have also been reported as surgical options such as in patients who fail initial GON decompression. 10,48,54 The role of occipital artery excision remains a topic of debate.…”

Section: Occipital (Including Sites IV and Vi) Surgerymentioning

confidence: 99%

“…In 1986, Blume and Ungar-Sargon 34 described percutaneous radiofrequency denaturation near the greater occipital nerve which produced good to excellent results in 85% of patients who had preoperative neuralgia responsive to GON block. Surgery at this area was later described as Site IV surgery by Guyuron et al 50 in 2005 and includes release of 6 recognized sites of occipital nerve compression: (1) between semispinalis capitis and obliques capitis inferior muscles, (2) as the nerve enters and (3) exits the semispinalis capitis muscle, (4) as the nerve enters the trapezius muscle, and (5) exits the trapezius fascia, and (6) by the occipital artery when it courses adjacent to the GON. 51,52 In a 2009 RCT by Guyuron et al 27 a semispinalis capitis myectomy and subcutaneous flap procedure to protect the nerve were superior to nerve exposure alone.…”

Section: Occipital (Including Sites IV and Vi) Surgerymentioning

confidence: 99%

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Outcomes of Surgical Treatment of Migraines: A Systematic Review & Meta-Analysis

et al. 2021

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Background: Migraine surgery at 1 of 6 identified “trigger sites” of a target cranial sensory nerve has rapidly grown in popularity since 2000. This study summarizes the effect of migraine surgery on headache severity, headache frequency, and the migraine headache index score which is derived by multiplying migraine severity, frequency, and duration. Materials and Methods: This is a PRISMA-compliant systematic review of 5 databases searched from inception through May 2020 and is registered under the PROSPERO ID: CRD42020197085. Clinical trials treating headaches with surgery were included. Risk of bias was assessed in randomized controlled trials. Meta-analyses were performed on outcomes using a random effects model to determine the pooled mean change from baseline and when possible, to compare treatment to control. Results: 18 studies met criteria including 6 randomized controlled trials, 1 controlled clinical trial, and 11 uncontrolled clinical trials treated 1143 patients with pathologies including migraine, occipital migraine, frontal migraine, occipital nerve triggered headache, frontal headache, occipital neuralgia, and cervicogenic headache. Migraine surgery reduced headache frequency at 1 year postoperative by 13.0 days per month as compared to baseline ( I2 = 0%), reduced headache severity at 8 weeks to 5 years postoperative by 4.16 points on a 0 to 10 scale as compared to baseline ( I2 = 53%), and reduced migraine headache index at 1 to 5 years postoperative by 83.1 points as compared to baseline ( I2 = 2%). These meta-analyses are limited by a small number of studies that could be analyzed, including studies with high risk of bias. Conclusion: Migraine surgery provided a clinically and statistically significant reduction in headache frequency, severity, and migraine headache index scores. Additional studies, including randomized controlled trials with low risk-of-bias should be performed to improve the precision of the outcome improvements.

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“…In the first few cases of GON decompression, we used the proximal approach suggested by some plastic surgeons in www.thenerve.net Noh C, et al Accurate GON Decompression for occipital neuralgia the United States [3][4][5][6]14) . However, it was inconvenient for us to extend the incision distally to decompress the GON in the trapezial tunnel 18) .…”

Section: Accurate Decompression Of the Gonmentioning

confidence: 99%

Referred Trigeminal Pain from Greater Occipital Nerve Entrapment: Importance of Accurate Greater Occipital Nerve Decompression

Noh

Lee

Son

2022

Nerve

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Occipital neuralgia is a unilateral or bilateral paroxysmal, shooting, or stabbing pain in the posterior part of the scalp, in the distribution of the greater, lesser occipital nerves 7) . In Trigeminocervical complex (TCC) sensitization by chronic entrapment of the greater occipital nerve (GON) often causes difficult-to-understand referred trigeminal facial pain along with occipital neuralgia. This report emphasizes the importance of accurate diagnosis and GON decompression by describing a case of a 51-year-old female patient with referred trigeminal pain from occipital neuralgia misdiagnosed as chronic migraine. The patient underwent incomplete decompression surgery. She presented with a relentless stinging and stabbing pain in her left hemiface and temporo-occipital area for 8 years. The pain occurred suddenly without improvement after long-term medical and injection treatment. She was diagnosed with chronic migraine and underwent so-called "migraine surgery" three years ago, but to no avail. Incomplete decompression of the bilateral GONs within the trapezial tunnel was confirmed under a microscopic oblique-paramedian approach. After accurate decompression, the chronic stabbing pain in the left facial and temporo-occipital region disappeared. Only intermittent numbness was felt. It is important to recognize occipital neuralgia caused by chronic GON entrapment and referred facial pain caused by TCC sensitization. Referred pain still often seems to be misunderstood as various other diseases. Direct decompression of the trapezial tunnel using a neurosurgical microscopic approach based on an accurate assessment of anatomical considerations may be important for GON decompression.

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Comprehensive Surgical Treatment of Migraine Headaches

Cited by 188 publications

References 28 publications

Measuring success in headache surgery: A comparison of different outcomes measures.

Measuring success in headache surgery: A comparison of different outcomes measures.

Outcomes of Surgical Treatment of Migraines: A Systematic Review & Meta-Analysis

Referred Trigeminal Pain from Greater Occipital Nerve Entrapment: Importance of Accurate Greater Occipital Nerve Decompression

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