BACKGROUND:
Background: Surgery for chronic intractable Migraine Headaches has been pioneered in the field of Plastic and Reconstructive surgery as the varied anatomy (nasal airway, face and neck neuroanatomy) particularly suites the field. With a growing number of supportive publications and surgeons performing the procedures, private insurance has slowly become increasingly receptive to coverage.
METHODS:
Methods: A retrospective analysis of 33 patients operated upon comparing preoperative and postoperative severity of disease (measured by Migraine Index) and disability (measured by MIDAS disability score) is reported. Additionally subjective improvement is also assessed. All patients are seen after full evaluation by a neurologist and are confirmed to have no recent change in the character of their chronic pain. All patients with the exception of two patients with Cluster Headaches were diagnosed with some variant of Migraine disease and failed traditional medical therapy - having tried at least three abortive medications and typically multiple preventative medications. Success is determined by 50% or greater improvement in either migraine index or by the patient’s subjective self assessment. - as is the criteria for preventative medication success.
RESULTS:
Results: 91 Migraine trigger deactivations (25 supraorbital nerves, 24 zygomaticotemperal nerves, 23 greater occipital nerves, 15 septoplasties/turbinectomies, and 4 auriculotemperal nerves) are performed over 6 years in 33 patients (age range 11 to 65 years) with follow up data on 31 patients. Candidacy for surgery was based on a detailed history, exam, responsiveness to Botulinum A testing, and when indicated a coronal CT scan of paranasal sinuses. Four patients are excluded as they are scheduled for further procedures. Average follow up from surgery was 27 months. Average follow up data is 18 months from time of surgery. Range of follow up is from one month to six years. Overall success was achieved in 21/27
(78%) of patients with an 81% average subjective improvement. There were 7/27 (26%) of patients with 100% improvement (no headaches since surgery). One patient is noted to have temporal hollowing. Two patients are noted to have persistent numbness of a portion of the frontal hairline. No complaint rated greater than 2 /10 in terms of severity.
CONCLUSIONS:
Conclusion: Surgical deactivation of Migraine trigger zones is a low-risk and effective option for patients who have failed conventional medical therapy. Further investigation is needed to determine options for treatment failures, exact the mechanism of action, and to accelerate the growing acceptance by private insurance companies.