Migraines affect 18% of women and 6% of men and result in an estimated $1 billion in medical costs and $16 billion productivity loss in the United States annually. Migraine headaches persist as a problem of this scale because pharmacologic treatments for migraines are frequently incompletely effective, resulting in a population of patients with significant residual disability. In the last decade, novel approaches to the treatment of migraines have been developed based on the theory that extracranial sensory branches of the trigeminal and cervical spinal nerves can be irritated, entrapped, or compressed at points throughout their anatomic course, ultimately leading to the cascade of physiologic events that results in migraine. Botulinum toxin (Botox) injection and surgical decompression of these trigger points have been shown to reduce or eliminate migraines in patients who are incompletely treated by traditional medical management. Despite the recent advances made with Botox, this treatment strategy most commonly results in only temporary migraine prevention. However, the evidence supporting the efficacy and safety of permanent surgical decompression of peripheral trigger points is accumulating rapidly, and the overall success rate of surgery has approached 90%. In addition, an abundance of literature investigating the precise anatomical dissections associated with trigger points has been published concurrently. This article reviews the most up-to-date clinical and anatomic evidence available and seeks to provide a comprehensive, concise resource for the current state of the art in the surgical treatment of migraine headaches.
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Columbus, Ohio; Dallas, Tex.; Washington, D.C.; St. Louis, Mo.; Cleveland, Ohio
From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; Medical Scientist Training Program, The University of Texas Southwestern Medical Center; Department of Plastic Surgery, Peripheral Nerve Surgery Institute, Georgetown University Hospital; Neuropax Clinic; and Department of Plastic Surgery, Case Western Reserve University.
Received for publication March 24, 2014; accepted April 21, 2014.
Disclosure: Dr. Janis was the recipient of a one-time honorarium from Pacira for attending a one-hour meeting in April, 2014. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.
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Jeffrey E. Janis, MD, Department of Plastic Surgery, Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, Ohio 43212, firstname.lastname@example.org