Migraine Surgery Offers Good Long-Term Outcomes

A follow-up study has found that surgery to deactivate migraine headaches (MHs) produces long-lasting results, with nearly 90% percent of patients having at least partial relief at five years' time.

Researchers at Case Western Reserve University School of Medicine (Cleveland, OH, USA) randomly assigned 125 volunteers to a treatment (100 patients) or control group (25 patients), after examination by the team neurologist to ensure a diagnosis of MH. The patients were asked to complete the SF-36, Migraine-Specific Quality of Life (MSQ), and Migraine Disability Assessment Scale (MIDAS) questionnaires prior to treatment and at postoperative follow-up at 12 and 60 months. The treatment group received botulinum toxin to confirm surgical deactivation of trigger sites, while controls received saline injections. The results were analyzed at one year (previously published), and at five years postoperatively.

The results showed that 89 patients in the treatment group underwent surgery, with 79 completing five-year follow-ups; 10 patients underwent deactivation of additional (different) trigger sites during the follow-up period, and were not included in the data analysis. The researchers found that 61 of 69 (88%) patients experienced a positive response to the surgery after five years. Of these, 20 (29%) reported complete elimination of MH, 41 (59%) noticed a significant decrease, and 8 (11%) experienced no significant change. When compared to the baseline values, all measured variables at 60 months improved significantly. The study was published in the February 2011 issue of Plastic and Reconstructive Surgery.

"The findings provide strong evidence that surgical deactivation of one or more trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headache, and the results are enduring,” concluded lead author Bahman Guyuron, MD, and colleagues of the department of plastic surgery. "More research will be needed to refine the surgical techniques -- as well as to clarify the reasons for the effectiveness of surgical deactivation of trigger sites in relieving migraine headaches.”

Migraine is a debilitating condition characterized by moderate to severe headaches, and is about three times more common in women than in men. The typical migraine headache is unilateral pain and pulsating in nature, lasting from 4 to 72 hours; symptoms include nausea, vomiting, photophobia, phonophobia, and is aggravated by routine activity. Approximately one-third of people who suffer from MHs perceive an aura—unusual visual, olfactory, or other sensory experiences that are a sign that the migraine will soon occur.

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Case Western Reserve University School of Medicine