Trigger Site Deactivation Surgery for Headaches is Associated with Decreased Postoperative Medication Use

Surgical Management of Headache Disorders - A Systematic Review of the Literature

PURPOSE OF REVIEW

This review article critically evaluates the latest advances in the surgical treatment of headache disorders.

RECENT FINDINGS

Studies have demonstrated the effectiveness of innovative screening tools, such as doppler ultrasound, pain drawings, magnetic resonance neurography, and nerve blocks to help identify candidates for surgery. Machine learning has emerged as a powerful tool to predict surgical outcomes. In addition, advances in surgical techniques, including minimally invasive incisions, fat injections, and novel strategies to treat injured nerves (neuromas) have demonstrated promising results. Lastly, improved patient-reported outcome measures are evolving to provide a framework for comparison of conservative and invasive treatment outcomes. Despite these developments, challenges persist, particularly related to appropriate patient selection, insurance coverage, delays in diagnosis and surgical treatment, and the absence of standardized measures to assess and compare treatment impact. Collaboration between medical/procedural and surgical specialties is required to overcome these obstacles.

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery

Background

Modern surgical therapy of chronic headaches/migraines is essentially based on the release/neurolysis of extracranial nerves, which, when compressed or inflamed, act as trigger points and, as such, trigger headache attacks. The aim of this article was to describe a novel maneuver we use as an aid in the preoperative planning of occipital trigger sites.

Methods

In the period of January 2021-September 2023, we operated on 32 patients (11 men, 21 women, age range: 26-68 years), who underwent migraine surgery for occipital trigger point release. All patients were evaluated using the described preoperative maneuver. In a dedicated card, the levels of tenderness at each point were marked accordingly, differentiating them by intensity as nothing (-), mild (+), medium (++), or high (+++). Patients were then operated on at the points corresponding only to the ++ and +++ signs.

Results

At 6-month follow-up, we observed significant improvement (>50%) in 29 patients (91%), with complete recovery in 25 patients (78%).

Conclusions

In our experience, the maneuver described, in addition to being very simple, has been shown to have good sensitivity and reproducibility. We therefore recommend its use, especially for those surgeons beginning their practice in this particular area of plastic surgery.

Frontal site surgery for chronic migraine therapy

BACKGROUND

According to the most current theories, chronic inflammation of some cranial nerves give rise to an inflammatory chain that would result in migraines. As for frontally located attacks, the nerves involved are two (on each side): the supraorbital and the supratrochlear. Surgical treatment includes complete neurolysis of both of these nerves.

METHODS

In this work, we describe our experience with this type of surgery. From 2011 to 2022, we treated 98 cases suffering from chronic migraine not responsive to drugs with frontal localization. The results were evaluated through a specific questionnaire three months and one year after surgery.

RESULTS

After three months post-surgery, we observed a success rate (reduction of monthly attacks equivalent to or greater than 50%) in 87% of patients (32% complete recovery). These results were essentially confirmed one year after surgery. The rare complications (mainly paresthesias and dysesthesias of the frontal area) have always resolved spontaneously within a few months.

CONCLUSION

The surgical approach allowed to obtain good therapeutic results with a low rate of complications.