Surgical Management of Migraine Headache

Abstract

Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 ± 6.3 episodes per month to 1.9 ± 2.4 episodes per month (P < 0.0001) postsurgery. The mean intensity of migraine headache also reduced from a preoperative 7.3 ± 3.5 to a postoperative of 1.3 ± 1.4 (P < 0.0001). Fourteen (46.7%) patients reported complete elimination of migraine after surgery while an equal number reported significant relief of symptoms. Two (6.6%) patients failed to notice any significant improvement after surgery. The mean follow-up period was 11.1 ± 2 months with no major surgical complications. Results of the authors' study confirm prior published results that surgical treatment of migraine is a reality. Surgeons can easily incorporate this simple surgical procedure in their armamentarium to offer relief to numerous migraine patients.

Medical Cannabis for the Treatment of Migraine in Adults: A Review of the Evidence

“…The non-response of all patients to commonly used medical treatments ( 3 ), patient-reported relief of migraine symptoms with medical cannabis use, and biological plausibility for how MC may work to treat migraines have contributed to the increased interest. It is also difficult to predict which patients will benefit from surgical procedures for chronic migraine, with some patients showing no improvement post-operation ( 6 , 7 ). As the number of states in the United States approving marijuana for medical use continues to increase, likely, migraine sufferers may choose cannabis to relieve their pain.…”

“…To provide relief for patients with chronic migraine, surgical management in the form of peripheral nerve decompression has been reported with some success. Although 47% of patients who had surgery reported complete elimination of migraine, some people with chronic migraine did not have any benefits, despite the risks of surgical exposure ( 6 , 7 ). This has led both physicians and patients to try dietary and herbal remedies, including the use of medical cannabis (MC) for migraine treatment ( 4 , 8 , 9 ).…”

“…Although surgical intervention for migraine has been explored, the surgical risks and inconsistent patient outcomes make it a less than desired treatment option. A recent study investigating the corrugator muscle's resection with the trigeminal nerve's zygomaticotemporal branch's avulsion eliminated migraine headaches in 47% of participants while 6.6% of patients did not show any improvement after surgery ( 7 ).…”

Associations between Zygoma Fracture and Post-Traumatic Headache: A Study among Taiwanese Population

“…A new hypothesis showed that zygoma-correlated PTH might be associated with auriculotemporal nerve (ATN) and zygomaticotemporal nerve (ZTN) injury [17,18]. Anatomically, both nerve pathways are extremely close to the zygomatic arch.…”

Extracranial Trigger Site Surgery for Migraine: A Systematic Review With Meta-Analysis on Elimination of Headache Symptoms

“…The heterogeneity in data and outcome reporting was high between studies. With the exception of Janis et al (39), Raposio et al (12), Guyuron et al (40), and Jose et al (41), studies did not report in detail whether unilateral or bilateral procedures were performed, therefore no further analysis based on laterality of the procedure was made. Six out of 14 studies report performing surgery on three or more surgical sites, among which are the three RCTs.…”