Background: Low efficacy, significant side effects, and refractory patients often limit the medical treatment of migraine headache. However, new surgical options have emerged. Dr. Bahman Guyuron and others report response rates between 68 and 95% after surgical deactivation of migraine trigger sites in select patients. In an effort to replicate and expand migraine trigger site deactivation surgery as a treatment option, our group and others have developed non-endoscopic algorithms. The exclusion of endoscopic techniques may be useful for surgeons with little experience or limited access to the endoscope as well as in patients with challenging anatomy.
Methods: Forty-three consecutive trigger deactivation procedures in thirty-five patients were performed. Preoperative and 12 month post-operative migraine questionnaires and patient charts were reviewed. Response to surgery in terms of migraine symptom relief and adverse events were evaluated.
Results: The overall positive response rate was 90.7%. Total elimination of migraine headaches was reported in 51.3%, greater than 80% resolution of symptoms in 20.5%, and 28.2% had resolution between 50-80%. No significant effect was reported after 9.3% of procedures. There were no major adverse events.
Conclusions: Non-endoscopic trigger deactivation is a safe and effective treatment in select migraine headache patients. While surgical techniques and understanding of the mechanisms of relief are evolving, results continue to be promising. This series confirms that excellent results can be attained without the endoscope. We continue to study these patients prospectively to improve patient selection and refine our protocol.
Level of Evidence: Therapeutic, IV.
(C)2014American Society of Plastic Surgeons