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A Prospective Randomized Outcomes Comparison of Two Temple Migraine Trigger Site Deactivation Techniques

Guyuron, Bahman M.D.; Harvey, Donald M.D.; Reed, Deborah M.D.

Plastic and Reconstructive Surgery: July 2015 - Volume 136 - Issue 1 - p 159–165
doi: 10.1097/PRS.0000000000001322
Reconstructive: Head and Neck: Original Articles
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Background: The authors compared the reduction of migraine headache frequency, days, severity, and duration after surgical decompression versus avulsion of the zygomaticotemporal branch of the trigeminal nerve for treatment of temporal migraine headache.

Methods: Twenty patients with bilateral temporal migraine headache were randomized to undergo avulsion of the zygomaticotemporal branch of the trigeminal nerve on one side and decompression via fasciotomy and removal of the zygomaticotemporal artery on the other side. Results were analyzed after a minimum of 12 months of follow-up.

Results: Nineteen patients completed the study. The patients experienced greater than 50 percent improvement in frequency, migraine days, severity, and duration in 34 of the 38 operative sites (89 percent). Complete elimination of symptoms was noted in 21 of the 38 operative sites (55 percent). In the decompression group, migraine frequency was reduced from 14.6 to 2.2 per month, migraine days from 14.1 to 2.3, severity from 7.0 to 2.9, duration from 9.6 to 4.8 hours, and Migraine Headache Index score from 42 to 2.9. In the neurectomy group, frequency decreased from 14.2 to 1.9 per month, migraine days from 14.1 to 2.3, severity from 6.8 to 2.6, migraine duration from 10.1 to 5.3 hours, and the Migraine Headache Index score from 41 to 2.5. There was no statistical significance in reduced migraine headache frequency, days, severity, and duration between the two groups.

Conclusions: Neurectomy and decompression of the zygomaticotemporal branch of the trigeminal nerve are both appropriate treatment for temporal migraine headache. If decompression fails to provide sufficient relief, neurectomy is another option.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Cleveland and Lyndhurst, Ohio

From the Department of Plastic Surgery, University Hospital Case Medical Center; and the American Migraine Center.

Received for publication July 14, 2014; accepted December 17, 2014.

Disclosure: The authors have no disclosures or conflicts of interest to declare pertaining to this article.

Bahman Guyuron, M.D., Department of Plastic Surgery, University Hospital Case Medical Center, 29017 Cedar Road, Lyndhurst, Ohio 44124, bahman.guyuron@gmail.com

©2015American Society of Plastic Surgeons