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Five-Year Outcome of Surgical Treatment of Migraine Headaches

Guyuron, Bahman M.D.; Kriegler, Jennifer S. M.D.; Davis, Janine R.N.; Amini, Saeid B. Ph.D., M.B.A., J.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3181fed456
Reconstructive: Head and Neck: Original Articles
Discussion
Press Release
Abstract

Background: This study was designed to assess the long-term efficacy of surgical deactivation of migraine headache trigger sites.

Methods: One hundred twenty-five volunteers were randomly assigned to the treatment (n = 100) or control group (n = 25) after examination by the team neurologist to ensure a diagnosis of migraine headache. Patients were asked to complete the Medical Outcomes Study 36-Item Short Form Health Survey, Migraine-Specific Quality of Life, and Migraine Disability Assessment questionnaires before treatment and at 12- and 60-month postoperative follow-up. The treatment group received botulinum toxin to confirm the trigger sites; controls received saline injections. Treated patients underwent surgical deactivation of trigger site(s). Results were analyzed at 1 year (previously published) and 5 years postoperatively (the subject of this report).

Results: Eighty-nine of 100 patients in the treatment group underwent surgery, and 79 were followed for 5 years. Ten patients underwent deactivation of additional (different) trigger sites during the follow-up period and were not included in the data analysis. The final outcome with or without inclusion of these 10 patients was not statistically different. Sixty-one (88 percent) of 69 patients have experienced a positive response to the surgery after 5 years. Twenty (29 percent) reported complete elimination of migraine headache, 41 (59 percent) noticed a significant decrease, and eight (12 percent) experienced no significant change. When compared with the baseline values, all measured variables at 60 months improved significantly (p < 0.0001).

Conclusion: Based on the 5-year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headache in a lasting manner.

Author Information

Cleveland, Ohio

From the Department of Plastic Surgery, Case Western Reserve University, and the Center for Headache and Pain, Cleveland Clinic.

Received for publication May 7, 2010; accepted August 11, 2010.

Presented at the American Society of Plastic Surgeons/Plastic Surgery Educational Foundation Annual Meeting, in Seattle, Washington, October 24, 2009.

Disclosure: The authors have no financial interest to declare in relation to the content of this artcle.

Bahman Guyuron, M.D.; 29017 Cedar Road; Cleveland (Lyndhurst), Ohio 44124; bguyuron@aol.com

©2011American Society of Plastic Surgeons