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Ormseth BH, ElHawary H, Huayllani MT, Weber KD, Blake P, Janis JE. Comparing Migraine Headache Index versus Monthly Migraine Days after Headache Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2024; 153:1201e-1211e. [PMID: 37285213 DOI: 10.1097/prs.0000000000010800] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nerve deactivation surgery for the treatment of migraine has evolved rapidly over the past 2 decades. Studies typically report changes in migraine frequency (attacks/month), attack duration, attack intensity, and their composite score-the Migraine Headache Index-as primary outcomes. However, the neurology literature predominantly reports migraine prophylaxis outcomes as change in monthly migraine days (MMD). The goal of this study was to foster common communication between plastic surgeons and neurologists by assessing the effect of nerve deactivation surgery on MMD and motivating future studies to include MMD in their reported outcomes. METHODS An updated literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Library of Medicine (PubMed), Scopus, and Embase were systematically searched for relevant articles. Data were extracted and analyzed from studies that met the inclusion criteria. RESULTS A total of 19 studies were included. There was a significant overall reduction in MMDs [mean difference (MD), 14.11; 95% CI, 10.95 to 17.27; I 2 = 92%], total migraine attacks per month (MD, 8.65; 95% CI, 7.84 to 9.46; I 2 = 90%), Migraine Headache Index (MD, 76.59; 95% CI, 60.85 to 92.32; I 2 = 98%), migraine attack intensity (MD, 3.84; 95% CI, 3.35 to 4.33; I 2 = 98%), and migraine attack duration (MD, 11.80; 95% CI, 6.44 to 17.16; I 2 = 99%) at follow-up (range, 6 to 38 months). CONCLUSION This study demonstrates the efficacy of nerve deactivation surgery on the outcomes used in both the plastic and reconstructive surgery and neurology literature.
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Affiliation(s)
| | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | | | - Kevin D Weber
- Neurology, Ohio State University Wexner Medical Center
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Stearns SA, Xun H, Haddad A, Rinkinen J, Bustos VP, Lee BT. Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review. Plast Reconstr Surg 2024; 153:988e-1001e. [PMID: 37337332 DOI: 10.1097/prs.0000000000010861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients. METHODS Currently available migraine therapeutics were compiled from the UpToDate software system and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic's effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and nonpharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care. RESULTS Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate postmicrosurgical use. Novel pharmaceutical therapies such as lasmiditan and calcitonin gene-related peptide antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of nonsteroidal antiinflammatory drugs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment by means of magnesium supplementation or coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting. CONCLUSIONS Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.
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Affiliation(s)
| | - Helen Xun
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Anthony Haddad
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Jacob Rinkinen
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Valeria P Bustos
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Bernard T Lee
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
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Henriques S, Almeida A, Peres H, Costa-Ferreira A. Current Evidence in Migraine Surgery: A Systematic Review. Ann Plast Surg 2022; 89:113-120. [PMID: 34611094 DOI: 10.1097/sap.0000000000002989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Migraine headache is a widespread neurovascular disorder with an enormous social and economic impact. A subgroup of patients cannot be managed with pharmacological therapy. Although surgical decompression of extracranial sensory nerves has been proposed as a valid alternative treatment option, the medical community remains reluctant to accept it. MATERIALS AND METHODS This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. An electronic search was performed in September 2020 on PubMed, ScienceDirect, CENTRAL, and Google Scholar databases for original articles reporting outcomes on migraine surgery. RESULTS The search strategy revealed a total of 922 studies, of which 52 were included in the review. Significant improvement was reported in 58.3% to 100% and complete elimination in 8.3% to 86.8% of patients across studies. No major complications were reported. DISCUSSION This systematic review demonstrates that migraine surgery is an effective and safe procedure, with a positive impact in patients' quality of life and a reduction in long-term costs. CONCLUSION There is considerable scientific evidence suggesting extracranial migraine surgery is an effective and safe procedure. This surgery should be considered in properly selected migraineurs refractory to medical treatment.
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Affiliation(s)
- Sara Henriques
- From the Department of Surgery and Physiology, Faculty of Medicine, Porto University
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Frattaroli JM, Torto FL, Turriziani G, Bruno E, Marcasciano M, Ribuffo D. Quality of online information about migraine headache surgery. J Plast Reconstr Aesthet Surg 2022; 75:3603-3607. [DOI: 10.1016/j.bjps.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/24/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
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Knoedler L, Chartier C, ElHawary H, Kehrer A, Muehlberger T. Letter to the Editor: The Case for Publicly Funded Headache Surgery in Germany. JPRAS Open 2021; 30:157-159. [PMID: 34703872 PMCID: PMC8526409 DOI: 10.1016/j.jpra.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022] Open
Abstract
Headache surgery has become a considerable therapeutic option in headache treatment and is of rising interest in the German medical sector. This viewpoint outlines the need for reimbursement of headache surgery in the German healthcare system and demonstrates its cost-effectiveness. Using state-of-the-art patient selection algorithms, the authors found headache surgery to be cost-effective within 7.2 to 6.3 years. Of note, the approach presented is not limited to the German healthcare system.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Muehlberger
- Department of Plastic Surgery and Hand Surgery, DRK-Kliniken Berlin Westend, Humboldt University Berlin, Berlin, Germany
- Migraine Surgery Centre, Harley Street, London, W1G 9PF, United Kingdom
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Lucia Mangialardi M, Baldelli I, Salgarello M, Raposio E. Decompression Surgery for Frontal Migraine Headache. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3084. [PMID: 33173664 PMCID: PMC7647648 DOI: 10.1097/gox.0000000000003084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Migraine headache (MH) is one of the most common diseases worldwide and pharmaceutical treatment is considered the gold standard. Nevertheless, one-third of patients suffering from migraine headaches are unresponsive to medical management and meet the criteria for "refractory migraines" classification. Surgical treatment of MH might represent a supplementary alternative for this category of patients when pharmaceutical treatment does not allow for satisfactory results. The goal of this article is to provide a comprehensive review of the literature regarding surgical treatment for site I migraine management. METHODS A literature search using PubMed, Medline, Cochrane and Google Scholar database according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted using the following MeSH terms: "frontal neuralgia," "frontal trigger site treatment," "frontal migraine surgery" and "frontal headache surgery" (period: 2000 -2020; last search on 12 March 2020). RESULTS Eighteen studies published between 2000 and 2019, with a total of 628 patients, were considered eligible. Between 68% and 93% of patients obtained satisfactory postoperative results. Complete migraine elimination rate ranged from 28.3% to 59%, and significant improvement (>50% reduction) rates varied from 26.5% to 60%. CONCLUSIONS Our systematic review of the literature suggests that frontal trigger site nerve decompression could possibly be an effective strategy to treat migraine refractory patients, providing significant improvement of symptoms in a considerable percentage of patients.
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Affiliation(s)
- Maria Lucia Mangialardi
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ilaria Baldelli
- Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate – DISC, Università degli Studi di Genova, L.go R. Benzi 10, 16132 Genova, Italy
| | - Marzia Salgarello
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Edoardo Raposio
- Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate – DISC, Università degli Studi di Genova, L.go R. Benzi 10, 16132 Genova, Italy
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Mathew PG, Najib U, Khaled S, Krel R. Prevalence of Occipital Neuralgia at a Community Hospital-based Headache Clinic. Neurol Clin Pract 2019; 11:6-12. [PMID: 33968466 DOI: 10.1212/cpj.0000000000000789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/15/2019] [Indexed: 12/25/2022]
Abstract
Background Occipital neuralgia (ON) is a paroxysmal disorder involving lancinating pain that originates in the neck or skull base with superior radiation toward the apex. ON more commonly occurs in patients with other coexisting headache disorders. There are limited data regarding the prevalence of ON. This study aims to demonstrate the prevalence of ON in a community hospital-based headache clinic. Methods This IRB-approved retrospective study was conducted at the Cambridge Health Alliance Headache Clinic. Medical records of patients presenting with headache as a chief complaint were reviewed from January 2010 to September 2015. Results Of 800 study patients, 81% were females (n = 648). A total of 195 patients were diagnosed with ON, and 146 patients had a positive occipital Tinel sign on examination. Isolated ON was present in 15.38% (n = 30) of patients. Multiple regression analysis demonstrated that the odds of ON were higher in patients with chronic migraine vs episodic migraine (adjusted odds ratio = 2.190 [95% confidence interval: 1.364-3.515]), even when adjusted for significant covariates. Conclusion ON occurred in nearly 25% of patients presenting with a chief complaint of headache to a community hospital-based headache clinic. Among patients with ON, 15% presented with ON as the chief complaint without another coexisting headache disorder. As such, up to 85% of ON cases occurred in patients having an additional headache type. Approximately 75% of patients with ON had a positive occipital Tinel sign on examination. Elevated body mass index, higher age at presentation, and chronic migraine increased the odds of having ON. Undiagnosed or inadequate treatment of ON can increase the frequency and intensity of other comorbid headache disorders.
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Affiliation(s)
- Paul G Mathew
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
| | - Umer Najib
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
| | - Shaoleen Khaled
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
| | - Regina Krel
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
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The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache. Plast Reconstr Surg 2019; 144:1431-1448. [PMID: 31764666 DOI: 10.1097/prs.0000000000006270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias. METHODS A systematic review was conducted to study the efficacy of decompression of extracranial sensory nerves as a treatment for neuralgia. Clinical studies were included that studied patients, aged 18 years or older, diagnosed with any definition of headache and were treated with extracranial nerve decompression surgery. Outcome parameters included intensity (on a 10-point scale), duration (in days), and frequency (of headaches per month). RESULTS Thirty-eight articles were found describing extracranial nerve decompression in patients with headaches. Postoperative decrease in headache intensity ranged from 2 to 8.2, reduction of duration ranged from 0.04 to 1.04 days, and reduction in frequency ranged between 4 and 14.8 headaches per month. Total elimination of symptoms was achieved in 8.3 to 83 percent of cases. A detailed summary of the outcome of single-site decompression is described. Statistical pooling and therefore meta-analysis was not possible, because of articles having the same surgeon and an overlapping patient database. CONCLUSIONS Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.
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Filipovic B, de Ru JA, Hakim S, van de Langenberg R, Borggreven PA, Lohuis PJFM. Treatment of Frontal Secondary Headache Attributed to Supratrochlear and Supraorbital Nerve Entrapment With Oral Medication or Botulinum Toxin Type A vs Endoscopic Decompression Surgery. JAMA FACIAL PLAST SU 2019; 20:394-400. [PMID: 29801115 DOI: 10.1001/jamafacial.2018.0268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Endoscopic surgical decompression of the supratrochlear nerve (STN) and supraorbital nerve (SON) is a new treatment for patients with frontal chronic headache who are refractory to standard treatment options. Objective To evaluate and compare treatment outcomes of oral medication, botulinum toxin type A (BoNT/A) injections, and endoscopic decompression surgery in frontal secondary headache attributed to STN and supraorbital SON entrapment. Design, Setting, and Participants Prospective cohort study of 22 patients from a single institution (Diakonessen Hospital Utrecht) with frontal headache of moderate-to-severe intensity (visual analog scale [VAS] score, 7-10), frontally located, experienced more than 15 days per month, and described as pressure or tension that intensifies with pressure on the area of STN and SON. A screening algorithm was used that included examination, questionnaire, computed tomography of the sinus, injections of local anesthetic, and BoNT/A in the corrugator muscle. Interventions Different oral medication therapy for headache encountered in the study cohort, as well as BoNT/A injections (15 IU) into the corrugator muscle. Surgical procedures were performed by a single surgeon using an endoscopic surgical approach to release the supraorbital ridge periosteum and to bluntly dissect the glabellar muscle group. Main Outcomes and Measures Headache VAS intensity after oral medication and BoNT/A injections. Additionally, early postoperative follow-up consisted of a daily headache questionnaire that was evaluated after 1 year. Results In total, 22 patients (mean [SD] age, 42.0 [15.3] years; 7 men and 15 women) were included in this cohort study. Oral medication therapy reduced the headache intensity significantly (mean [standard error of the mean {SEM}] VAS score, 6.45 [0.20] [95% CI, 0.34-3.02; P < .001] compared with mean [SEM] pretreatment VAS score, 8.13 [0.22]). Botulinum toxin type A decreased the mean (SEM) headache intensity VAS scores significantly as well (pretreatment, 8.1 [0.22] vs posttreatment, 2.9 [0.42]; 95% CI, 3.89-6.56; P < .001). The mean (SEM) pretreatment headache intensity VAS score (8.10 [0.22]) decreased significantly after surgery at 3 months (1.30 [0.55]; 95% CI, 5.48-8.16; P < .001) and 12 months (1.09 [0.50]; 95% CI, 5.71-8.38; P < .001). There was a significant decrease of headache intensity VAS score in the surgical group over the BoNT/A group (mean [SEM] VAS score, 2.90 [0.42]) after 3 months (mean [SEM] VAS score, 1.30 [0.55]; 95% CI, 0.25-2.93; P < .001) and 12 months (mean [SEM] VAS score, 1.09 [0.50]; 95% CI, 0.48-3.16; P < .001) after surgery. Conclusions and Relevance Endoscopic decompression surgery had a long-lasting successful outcome in this type of frontal secondary headache. Even though BoNT/A had a positive effect, the effect of surgery was significantly higher. Level of Evidence 3.
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Affiliation(s)
- Boris Filipovic
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - J Alexander de Ru
- Department of Otorhinolaryngology-Head and Neck Surgery, Central Military Hospital, Utrecht, the Netherlands
| | - Sara Hakim
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - Rick van de Langenberg
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - Pepijn A Borggreven
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - Peter J F M Lohuis
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
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11
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12
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de Ru JA, Filipovic B, Lans J, van der Veen EL, Lohuis PJ. Entrapment Neuropathy: A Concept for Pathogenesis and Treatment of Headaches-A Narrative Review. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619834949. [PMID: 30906196 PMCID: PMC6421593 DOI: 10.1177/1179550619834949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/03/2019] [Indexed: 12/17/2022]
Abstract
Entrapment neuropathy is a known cause of neurological disorders. In the head and neck area, this pathophysiological mechanism could be a trigger for headache. Over the last few decades, injection of botulinum toxin type A in the muscles that are causing the compression as well as surgical decompression have proved to be effective treatment methods worldwide for large numbers of patients with daily headaches. In particular the entrapment of the supraorbital nerves in the glabellar musculature and the occipital nerves in the neck musculature are triggers for headache disorders for which many patients are still seeking an effective treatment. This article reviews the literature and aims to bring the concept of neural entrapment to the attention of a wider audience. By doing so, we hope to give more exposure to an effective and relatively safe headache treatment.
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Affiliation(s)
- J Alexander de Ru
- Department of Otorhinolaryngology - Head and Neck Surgery, Central Military Hospital 'Dr. A. Mathijsen', Utrecht, The Netherlands
| | - Boris Filipovic
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erwin L van der Veen
- Department of Otorhinolaryngology - Head and Neck Surgery, Central Military Hospital 'Dr. A. Mathijsen', Utrecht, The Netherlands
| | - Peter Jfm Lohuis
- Department of Otorhinolaryngology - Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, The Netherlands
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13
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Vincent AJPE, van Hoogstraten WS, Maassen Van Den Brink A, van Rosmalen J, Bouwen BLJ. Extracranial Trigger Site Surgery for Migraine: A Systematic Review With Meta-Analysis on Elimination of Headache Symptoms. Front Neurol 2019; 10:89. [PMID: 30837930 PMCID: PMC6383414 DOI: 10.3389/fneur.2019.00089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/23/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction: The headache phase of migraine could in selected cases potentially be treated by surgical decompression of one or more “trigger sites,” located at frontal, temporal, nasal, and occipital sites. This systematic review with subsequent meta-analysis aims at critically evaluating the currently available evidence for the surgical treatment of migraine headache and to determine the effect size of this treatment in a specific patient population. Methods: This study was conducted following the PRISMA guidelines. An online database search was performed. Inclusion was based on studies published between 2000 and March 2018, containing a diagnosis of migraine in compliance with the classification of the International Headache Society. The treatment must consist of one or more surgical procedures involving the extracranial nerves and/or arteries with outcome data available at minimum 6 months. Results: Eight hundred and forty-seven records were identified after duplicates were removed, 44 full text articles were assessed and 14 records were selected for inclusion. A total number of 627 patients were included in the analysis. A proportion of 0.38 of patients (random effects model, 95% CI [0.30–0.46]) experienced elimination of migraine headaches at 6–12 months follow-up. Using data from three randomized controlled trials, the calculated odds ratio for 90–100% elimination of migraine headaches is 21.46 (random effects model, 95% CI [5.64–81.58]) for patients receiving migraine surgery compared to sham or no surgery. Conclusions: Migraine surgery leads to elimination of migraine headaches in 38% of the migraine patients included in this review. However, more elaborate randomized trials are needed with transparent reporting of patient selection, medication use, and surgical procedures and implementing detailed and longer follow-up times.
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Affiliation(s)
- Arnaud J P E Vincent
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Antoinette Maassen Van Den Brink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bibi L J Bouwen
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
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Wormald JCR, Luck J, Athwal B, Muelhberger T, Mosahebi A. Surgical intervention for chronic migraine headache: A systematic review. JPRAS Open 2019; 20:1-18. [PMID: 32158867 PMCID: PMC7061614 DOI: 10.1016/j.jpra.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/06/2019] [Indexed: 01/10/2023] Open
Abstract
A focus on sound systematic review methodology to present an unbiased and scientific assessment of the body of knowledge for migraine surgery. Comprehensive search strategy included a range of study types to capture all relevant reports of primary clinical research, enabling a global evaluation of the topic. A descriptive analysis allowing an overview of the likely effect of a variety of surgical interventions, with a snapshot of the rates of recurrence and adverse events. Formalised assessment of methodological quality using the GRADE approach identifies specific flaws affecting the reliability of migraine surgery research to date. Limited by a paucity of methodological quality in included studies, heterogeneous interventions, inconsistent outcome reporting and variability in baseline data, intervention data and outcome data.
Aims Migraine is a global phenomenon, affecting more than 10% of the world's population. It is characterized by unilateral headache that may be accompanied by vomiting, nausea, photophobia and phonophobia. Some patients with chronic migraine respond to extra-cranial botulinum toxin type A injection, although the benefits observed are temporary. The rationale for surgical trigger site deactivation is to achieve lasting symptomatic improvement or permanent relief from migraine. Methods We performed a PRISMA-compliant systematic review of clinical studies evaluating surgical intervention for migraine by searching Ovid MEDLINE and EMBASE databases from inception to June 2017. Studies were independently screened by two authors. Data were extracted on study characteristics, migraine outcomes, adverse events and recurrence. The quality of evidence was assessed using the GRADE approach. The review protocol was prospectively registered on the PROSPERO database (CRD42017068577). Results The search strategy identified 789 articles; of them, 18 studies (4 RCTs and 14 case series) were eligible for analysis. Surgical interventions were heterogeneous and variably involved peripheral nerve decompression by myectomy or foraminotomy, nerve excision, artery resection and/or nasal surgery. All studies reported significant reductions in migraine intensity, frequency, duration and composite headache scores following surgery. Study heterogeneity precluded formal meta-analysis. Where reported, adverse event rates varied markedly between studies. The quality of included studies was consistently low or very low. Conclusion There is insufficient evidence to support the effectiveness of any specific surgical intervention for chronic migraine, especially with regard to permanent relief; however, all included studies report improvements in key outcomes following migraine surgery. A definitive, well-powered RCT with objective surgical and patient-reported outcome measures and robust adverse event reporting is required.
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Affiliation(s)
- J C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX1 2DJ, United Kingdom.,Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire HP21 8AL, United Kingdom
| | - J Luck
- Department of Plastic Surgery, Royal Free Hospital NHS Trust, Pond Street, London NW3 2QG, United Kingdom.,Division of Surgery and Interventional Sciences, Faculty of Medical Sciences, University College London, WC1E 6BT, United Kingdom
| | - B Athwal
- Department of Neurology, Royal Free Hospital NHS Trust, Pond Street, London NW3 2QG, United Kingdom
| | - T Muelhberger
- Migraine Surgery Centre, Harley Street, London W1G 9PF, United Kingdom
| | - A Mosahebi
- Department of Plastic Surgery, Royal Free Hospital NHS Trust, Pond Street, London NW3 2QG, United Kingdom.,Division of Surgery and Interventional Sciences, Faculty of Medical Sciences, University College London, WC1E 6BT, United Kingdom
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15
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Abstract
Post-traumatic headache (migraine) is the most common symptom of concussion and traumatic brain injury. An expert opinion-based review along with a literature review (PubMed) was conducted looking at known interventional procedures for post-traumatic headache using the keywords post-traumatic headache, post-traumatic migraine headache, concussion, mild traumatic brain injury, and traumatic brain injury and the following categories: mechanism, pathophysiology, treatment, physical therapy, neurostimulation, Botox@/Onabotulinum toxin, and surgical intervention. The results returned a total of 181 articles of which 52 were selected. None of the articles included randomized placebo-controlled studies, and most were either prospective or retrospective case analysis and/or review articles or consensus opinion papers, with most studies yielding positive results. Despite a lack of hard evidence, interventional procedures, alone or in combination, appear to be an effective treatment for post-traumatic headaches.
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Affiliation(s)
- Francis X Conidi
- Florida Center for Headache and Sports Neurology, 2525 Burns Road, Palm Beach Gardens, FL, 33410, USA.
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16
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Filipović B, de Ru JA, van de Langenberg R, Borggreven PA, Lacković Z, Lohuis PJFM. Decompression endoscopic surgery for frontal secondary headache attributed to supraorbital and supratrochlear nerve entrapment: a comprehensive review. Eur Arch Otorhinolaryngol 2017; 274:2093-2106. [DOI: 10.1007/s00405-017-4450-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
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17
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Evaluation of Migraine Surgery Outcomes through Social Media. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1084. [PMID: 27826478 PMCID: PMC5096533 DOI: 10.1097/gox.0000000000001084] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Social media have been used to study many aspects of health and human behavior. Although social media present a unique opportunity to obtain unsolicited patient-reported outcomes, its use has been limited in plastic and reconstructive surgical procedures, including migraine nerve surgery. The goal of this study was to utilize the most popular social media site, Facebook, to evaluate patients' experience with migraine surgery. METHODS Six months of data regarding nerve surgery, nerve stimulators, and radiofrequency nerve ablation were collected from posts and comments written by members of 2 Facebook groups. Outcomes were classified by degree of resolution of symptoms. RESULTS A total of 639 posts related to migraine surgery. Of 304 posts commenting on postoperative success of nerve surgery, 16% reported elimination of headaches and 65% significant improvement (81% with complete or significant improvement), 5% partial improvement, 11% no change, and 3% worsening symptoms. Nerve surgery had a higher success rate than nerve stimulators and radiofrequency ablation. Nerve surgery was recommended by 90% of users. CONCLUSIONS The 81% rate of complete or significant improvement of symptoms in this study is close to the 79% to 84% shown in current literature. Similar to the findings of a recent systematic review, surgery is more efficacious compared with nerve stimulators and ablation. This study adds to evidence favoring migraine surgery by removing evaluator bias and demonstrates that surgical outcomes and satisfaction data may be obtained from social media.
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18
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Abstract
PURPOSE OF REVIEW Management of headache disorders is not part of most craniomaxillofacial surgery practices; however there are certain indications for surgical management of headaches by the craniomaxillofacial surgeon. RECENT FINDINGS Migraine headaches are the most amenable to surgical management and while the exact mechanism of migraine is unknown, a central or peripheral trigger such as compressive neuropathy of trigeminal nerve branches leading to neurogenic inflammation has been suggested. The primary management for episodic migraine headache should be lifestyle modification and medication, whereas for chronic migraine (>15 headache days/month) use of medication and botulinum neurotoxin is effective, whereas some patients may choose to explore surgical options. Trigger site decompression for chronic migraine surgically relieves anatomic impingement at various sites and has been shown to reduce by at least 50% the frequency, intensity, and duration of headaches in over 85% and elimination of headaches in almost 60%. Trigger points may also lead to exacerbation of cluster headaches and treatment with botulinum neurotoxin may reduce attacks. SUMMARY Trigger site decompression is an effective treatment for chronic migraine, as are botulinum neurotoxin injections in reducing attacks in cluster headaches. The craniomaxillofacial surgeon is uniquely qualified to treat these primary headache disorders.
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19
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de Ru JA. Migraine Trigger Site Surgery is All Placebo. Headache 2016; 56:776-8. [PMID: 27092535 DOI: 10.1111/head.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jacob A de Ru
- University Medical Center Utrecht - Otolaryngology -Head Neck Surgery, Heidelberglaan 100, Utrecht, 3584, CX, Netherlands
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20
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Abstract
Headaches are a very common disorder, more common than asthma and diabetes combined. Migraine is the most common headache disorder, but it remains underdiagnosed and therefore undertreated. The treatment of migraines is divided into acute and prophylaxis. Patients who are experiencing 8 or more headaches a month or those who experience disability with their headaches as determined by the Migraine Disability Assistance Score or MIDAS should be placed on prophylaxis.
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Affiliation(s)
- Grace Forde
- North American Partners in Pain Management, Department of Pain Medicine, 900 Franklin Avenue, Valley Stream, NY 11580, USA.
| | - Robert A Duarte
- Department of Neurology, Pain Center, Cushing Neuroscience Institute, North Shore-LIJ Health System, 611 Northern Boulevard, Great Neck, NY 11021, USA
| | - Noah Rosen
- Department of Neurology, North Shore Headache Center, Cushing Neuroscience Institute, Hofstra North Shore LIJ Medical Center, 611 Northern Boulevard, Great Neck, NY 11021, USA; Department of Psychiatry, North Shore Headache Center, Cushing Neuroscience Institute, Hofstra North Shore LIJ Medical Center, 611 Northern Boulevard, Great Neck, NY 11021, USA
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21
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Guyuron B. Is Migraine Surgery Ready for Prime Time? The Surgical Team's View. Headache 2015; 55:1464-73. [DOI: 10.1111/head.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Bahman Guyuron
- Emeritus Professor of Plastic Surgery, Case School of Medicine; Cleveland OH USA
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22
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Mathew PG. A critical re-evaluation of migraine trigger site decompression surgery. Headache 2015; 54:1231-3. [PMID: 25040812 DOI: 10.1111/head.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paul G Mathew
- Department of Neurology, John R. Graham Headache Center, Brigham and Women's Hospital, Boston, MA, USA; Division of Neurology, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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23
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Mathew PG, Robbins L. Cranial neuralgia vs entrapment neuropathy decompression … better names than migraine trigger site deactivation surgery. Headache 2015; 55:706-10. [PMID: 25882274 DOI: 10.1111/head.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Paul G Mathew
- Department of Neurology, John R. Graham Headache Center, Brigham and Women's Hospital, Boston, MA, USA.,Division of Neurology, Cambridge Health Alliance, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
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24
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de Ru J. More comments on migraine trigger site decompression surgery: focus on frontal headache. Headache 2015; 55:702-6. [PMID: 25877864 DOI: 10.1111/head.12557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jacob de Ru
- University Medical Center Utrecht - Pain Clinic, Department of Anesthesiology, Heidelberglaan, 100, Utrecht, Netherlands.,Central Military Hospital, Lundlaan 1, Utrecht, Netherlands
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25
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Guyuron B. A discussion of "critical evaluation of migraine trigger site decompression surgery". Headache 2015; 54:1065-72. [PMID: 24916595 DOI: 10.1111/head.12370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Bahman Guyuron
- Department of Plastic Surgery, Case Western Reserve University, Cleveland, OH, USA
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26
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Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society. Acta Neurol Belg 2015; 115:1-17. [PMID: 24968722 DOI: 10.1007/s13760-014-0313-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/13/2014] [Indexed: 12/24/2022]
Abstract
Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres.
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28
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Abstract
Chronic pain impairs the quality of life for millions of individuals and therefore presents a serious ongoing challenge to clinicians and researchers. Debilitating chronic pain syndromes cost the US economy more than $600 billion per year. This article provides an overview of the epidemiology, clinical presentation, and treatment outcomes for craniofacial, spinal, and peripheral neurologic pain syndromes. Although the authors recognize that the diagnosis and treatment of the chronic forms of neuropathic pain syndromes represent a clinical challenge, there is an urgent need for standardized classification systems, improved epidemiologic data, and reliable treatment outcomes data.
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29
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