Background: This study reports the surgical technique and efficacy of deactivation of occipital-triggered migraine headaches. In addition, it reports the effect of surgical deactivation of occipital-triggered migraine headaches on migraine triggers and associated symptoms other than pain.
Methods: One hundred ninety-five patients undergoing surgery for occipital-triggered migraine headaches performed by a single surgeon, and followed for at least 1 year, were analyzed. Median regression adjusted for age, sex, and follow-up time was used to determine postoperative reduction in occipital-specific Migraine Headache Index, which is the product of migraine duration, frequency, and severity. Reduction in migraine-days was also measured. The association between symptom or trigger resolution and occipital-specific Migraine Headache Index reduction was studied by logistic regression. Details of surgical treatment are discussed and complication rates reported.
Results: Eighty-two percent of patients (n = 160) reported successful surgery at least 12 months postoperatively (mean follow-up, 3.67 years). Eighty-six percent (n = 168) had successful surgery as measured by migraine-days. Fifty-two percent reported complete occipital-triggered migraine headaches elimination. Symptoms resolving with successful surgery beyond headache include being bothered by light and noise, feeling lightheaded, difficulty concentrating, vomiting, blurred/double vision, diarrhea, visual aura, numbness and tingling, speech difficulty, and limb weakness (p < 0.05). Triggers resolving with successful surgery include missed meals; bright sunshine; loud noise; fatigue; certain smells; stress; certain foods; coughing, straining, and bending over; letdown after stress; and weather change (p < 0.05).
Conclusions: Surgical deactivation of occipital-triggered migraine headaches provides long-lasting migraine relief. Successful site IV surgery is associated with changes in specific symptoms and triggers. This can assist in trigger avoidance and aid occipital-triggered migraine headache trigger-site identification.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Cleveland, Ohio
From Case Western Reserve University School of Medicine; the Department of Plastic Surgery, University Hospitals; and the Department of Epidemiology and Biostatistics, Case Western Reserve University.
Received for publication September 14, 2016; accepted December 12, 2016.
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
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Bahman Guyuron, M.D., 29017 Cedar Road, Cleveland, Ohio 44124, bahman.guyuron@gmail.com
