Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery- A prospective cohort study

Abstract

areful selection of headache surgery candidates is essential to optimizing surgical outcomes. [1][2][3][4] Current screening algorithms include pain drawings, clinical history and physical examination, ultrasound, Doppler imaging, and diagnostic nerve blocks. [5][6][7][8][9] Furthermore, some patients undergo radiographic imaging such as computed tomography. 10,11 Several screening algorithms in the past have relied on positive response to botulinum toxin type A injections. [12][13][14][15] Although a history of positive response to botulinum toxin type A should still be noted during patient screening, preoperative botulinum toxin type A injection requires Background: Experts agree that nerve block (NB) response is an important tool in headache surgery screening. However, the predictive value of NBs remains to be proven in a prospective fashion. Methods: Pre-NB and post-NB visual analogue pain scores (0 to 10) and duration of NB response were recorded prospectively. Surgical outcomes were recorded prospectively by calculating the Migraine Headache Index (MHI) preoperatively and postoperatively at 3 months, 12 months, and every year thereafter. Results:The study population included 115 patients. The chance of achieving MHI percentage improvement of 80% or higher was significantly higher in subjects who reported relative pain reduction of greater than 60% following NB versus less than or equal to 60% [63 of 92 (68.5%) versus 10 of 23 (43.5%); P = 0.03]. Patients were more likely to improve their MHI 50% or more with relative pain reduction of greater than 40% versus 40% or less [82 of 104 (78.8%) versus five of 11 (45.5%); P = 0.01]. In subjects with NB response of greater than 15 days, 10 of 13 patients (77.0%) experienced MHI improvement of 80% or greater. Notably, all of these patients (100%) reported MHI improvement of 50% or greater, with mean MHI improvement of 88%. Subjects with a NB response of 24 hours or more achieved significantly better outcomes than patients with a shorter response (72.7% ± 37.0% versus 46.1% ± 39.7%; P = 0.02). However, of 14 patients reporting NB response of less than 24 hours, four patients had MHI improvement of 80% or greater, and seven, of 50% or greater. Conclusions: Relative pain reduction and duration of NB response are predictors of MHI improvement after headache surgery. NBs are a valuable tool to identify patients who will benefit from surgery.

Refractory occipital neuralgia treatment with nerve decompression surgery: a case series

“…Risk factors have been previously described in the literature and include poor NB response, atypical pain drawings, RFA, and cervical spine disorders. While most patients in our series had days to weeks of ON headache relief with NB at the time of screening, both patients had the lowest duration lasting < 48 h. It has been reported that a NB response of < 24 h is associated with worse outcomes following nerve decompression surgery ( 48 ). An absence of NB response would conflict with the diagnostic criteria of ON set forth by the ICDH-3 and can be a relative contraindication to surgery.…”

Feasibility of Ultrasound Measurements of Peripheral Sensory Nerves in Head and Neck Area in Healthy Subjects

“…21 Diagnostic nerve blocks with corticosteroids or anesthetics are currently used to confirm this diagnosis. 41,42 Also, a positive response to botulin toxin type A is used to confirm nerve compression headache. 14 However, these methods are invasive procedures, and using less-invasive methods to diagnose nerve compression headaches would be preferable.…”

Treatment Delay in Patients Undergoing Headache Surgery (Nerve Decompression Surgery)

“…The unit cost and quantity of each variable were derived from previous research work. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 The quantity of each variable was then multiplied by the utilization in our patient cohort and applied to the respective unit costs. The costs of oral drug therapy were deduced from the literature.…”