Surgical therapy of migraine: a 12-year single-center experience

Abstract

Background In recent years, surgical therapy has taken on an increasingly decisive role in the therapeutic armamentarium of migraine. All surgical techniques are aimed at the complete neurolysis of some extra-cranial nerves, of which the most involved (in our experience) are the greater and lesser occipital, auriculotemporal, supraorbital, and supratrochlear nerves. This paper describes our surgical approaches for the treatment of occipital, temporal, and frontal trigger sites. Methods A single-center, retrospective study was conducted on all patients who underwent surgical treatment of migraine between 2011 and 2022. Patients were asked to fill out a headache diary and complete a migraine questionnaire assessing parameters before surgery, after 3 months, and 1 year after surgery. Data regarding age, sex, age at onset, migraines per month (in days), associated symptoms, severity (on a scale from 1 to 10), inability to work per month (in days), health status, history of neck trauma, and family history were collected. The Migraine Disability Assessment Scale (MIDAS) score was also used to evaluate the degree of disability for each patient. Results We have operated on 612 patients: n.266 occipital, n.248 temporal, n.98 frontal. The surgical procedure elicited a positive response in 90% of the patients (69% complete recovery). Complications were mild and temporary: mainly, hypoesthesia and numbness of the undermined areas, lasting from 3 weeks to 6 months. We observed the onset of secondary trigger sites in 257 (42%) patients. Discussion The described procedure is minimally invasive and highly reproducible and allows to obtain a high degree of success with a negligible rate of complications. Nevertheless, given the high percentage of occurrence of secondary trigger points, it is particularly important to warn the patient of this possibility in pre-operative visits. Level of evidence: Level III, Therapeutic

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery

“…The aim of this work was to describe a semeiological maneuver we introduced as an aid in the preoperative screening of these patients, based on clinical experience gained over the past 12 years. 25–30…”

“…The aim of this work was to describe a semeiological maneuver we introduced as an aid in the preoperative screening of these patients, based on clinical experience gained over the past 12 years. [25][26][27][28][29][30] First, the patient is asked to flex the head, in such a way as to bring the chin as close as possible to the left shoulder. At this point, we imagine an oblique line, near the superior nuchal line, which ideally joins the inion with the inferior apex of the right mastoid process (Fig.…”