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Intraoperative Corticosteroid Injections in Migraine Surgery

Efficacy in Preventing Refractory Symptoms

Lineberry, Kyle M.D.; Lee, Michelle M.D.; Monson, Andrea B.S.; Guyuron, Bahman M.D.

Plastic and Reconstructive Surgery: February 2015 - Volume 135 - Issue 2 - p 393e–396e
doi: 10.1097/PRS.0000000000000862
Reconstructive: Head and Neck: Original Articles
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Background: A subset of patients have been noted to have refractory migraine symptoms in site IV (occipital triggers) following primary surgery. It was postulated that the cause of refractory migraine symptoms is new scar tissue formation causing irritation of the greater occipital nerve. The goal of this study was to determine whether intraoperative corticosteroid injections have the potential to prevent these refractory symptoms.

Methods: A retrospective review of all patients operated on by the senior author (B.G.) from 2000 to 2010 was undertaken. All patients who had site IV decompression and at least 1 year of follow-up were included. Patients were divided into two groups, those who had corticosteroids injected and those who did not. Data analyzed included demographics and preoperative and postoperative migraine headache symptoms review based on the migraine headache questionnaire.

Results: A total of 476 patients were included in the study. There were 282 patients in the corticosteroid group and 194 in the no-corticosteroid group. A significant reduction was found in the frequency of migraine headaches (−9.8 versus −8.0; p = 0.03) and the migraine headache index (−92.9 versus −65.2; p = 0.0065). There was no significant reduction in migraine headache duration (−0.50 versus −0.70; p = 0.10) or severity (−3.50 versus −3.80; p = 0.38).

Conclusions: Intraoperative injection of corticosteroids during site IV migraine surgery may reduce migraine frequency and migraine headache index postoperatively. Corticosteroid injection in migraine site IV surgery is an effective adjunctive measure in reducing the migraine headache index.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Cleveland, Ohio

From the Department of Plastic Surgery, University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; and the Department of Plastic Surgery, Case Western Reserve University.

Received for publication May 23, 2014; accepted August 14, 2014.

Presented at the 55th Annual Meeting of the Ohio Valley Society of Plastic Surgeons, in Cleveland, Ohio, May 18 through 19, 2012.

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

Bahman Guyuron, M.D., 29017 Cedar Road, Cleveland (Lyndhurst), Ohio 44124, bahman.guyuron@gmail.com

©2015American Society of Plastic Surgeons