Septorhinoplasty as a treatment modality in refractory migraine headaches

Abstract

Migraine headaches are fairly common among people throughout the world with many treatment modalities. The cornerstone of treatment has been traditionally medical treatment which is mostly symptomatic and needs to be repeated. A few surgical procedures have been proposed which eliminate the inciting factor, and septorhinoplasty is one of them. Between October 2001 and August 2004, 24 patients suffering from migraine headaches, underwent septorhinoplasty at 15th Khordad Hospital, Tehran, Iran. Our inclusion criteria were refractory migraine, contact points demonstrated by computed tomography scan, and significant headache improvement after topical anesthesia to the contact area. Reduced severity and frequency of migraine headaches were documented which is statistically significant (p<0.05). Septorhinoplasty in selected patients with contact points could reduce frequency, severity, and duration of migraine attacks.

Current Evidence in Migraine Surgery

“…13,15,18,42 On the nasal site, septoplasty with or without turbinectomy is usually performed to eliminate aberrant intranasal contact points. 18,33,37,48 The breakthrough of the extracranial surgical treatment of migraine headaches came in 2000, after a retrospective review by Dr Bahman Guyuron suggested for the first time a correlation between corrugator supercilii muscle resection and the elimination or significant improvement of migraine headaches. Of the 39 participants included in this study, 79.5% reported significant improvement and 38.5% complete elimination of their migraine headaches.…”

“…68,69 Regarding the level of evidence, 5 studies were classified as level 1 studies, 18,28-31 9 as level 2 studies, 12,27,35,36,38,40,41,45,62 9 as level 3 studies, 14,15,20,[50][51][52]61,63,64 and 25 as level 4 studies. 10,11,13,16,[32][33][34]37,39,[42][43][44][47][48][49]53,54,[56][57][58][59][60][65][66][67] In 4 studies 46,55,68,69 the level of evidence could not be determined because of the studies' design. Regarding the journal of publication, 47 studies were published in plastic surgery journals (34 in Plastic and Reconstructive Surgery Journal, 1 in Aesthetic Su...…”

“…In 6 studies, the minimum follow-up period was not specified. Regarding the trigger site addressed, 10 studies focused exclusively on the frontal site, 11,12,16,27,34,43,50,52,59,64 5 on the temporal site, 28,41,49,60,65 9 on the occipital site, 13,15,39,42,47,51,53,54,63 4 on the nasal site, 14,33,37,48 and 20 on multiple sites. 10,18,20,[29][30][31][32]35,38,40,[44][45][46][56][57][58]61,62,66,67 In 4 studies, the addressed trigger site was not specified.…”

“…Three of these trials were described as double-blinded. 27,28,30 Of the 44 nonrandomized studies assessed with the MINORS scale, 25 34 were considered to be of high quality (77%) 10,11,[13][14][15][32][33][34][36][37][38][39][40][41][42][43][44][45][46][47][49][50][51][52]54,[57][58][59][60][61][62][63][64]66 and 10 of low quality (23%). 12,16,20,35,48,53,55,56,65,67 Finally, one of the economic analysis 68 fulfills 17 items and the other 69 18 items out of the 19 items on the CHEC-list, ...…”

The Evolution of Migraine Surgery: Two Decades of Continual Research. My Current Thoughts

“…Many of our colleagues have confirmed the efficacy of this operation through studies from a variety of centers, and this operation has become an integral part of the field of peripheral nerve surgery. Technique modifications have included the introduction of the nonendoscopic, transpalpebral approach to treat the zygomaticotemporal trigger site, 55 use of a modified incision for greater occipital nerve–related headaches, 68 and other 45–68 modifications.…”