Commonly, migraine surgery outcomes are evaluated using migraine-specific questionnaires such as MHI, the Migraine Disability Assessment Survey, the Migraine-Specific Quality-of-Life Questionnaire, and the Headache Impact Test. This is the first study to include an instrument widely used in better understood and more common pain patient populations (PSEQ).
Migraine surgery outcomes continue to show promising results when patients are chosen carefully. In this prospective cohort, all outcome measures including migraine headache frequency, duration, pain, MHI total score, and PSEQ improved significantly from baseline (Tables 1 and 2).
The increase in mean PSEQ score after migraine surgery was remarkable, with an improvement of 112 percent after surgery (Table 2 and Fig. 1). This is important, as PSEQ scores describe pain coping during daily activities and therefore extent of disability during everyday life. Rather than evaluating changes in migraine severity, it indicates the functional change that patients experience after migraine surgery. Improved functional outcome is ultimately more important than change in migraine characteristics (i.e., frequency, duration, and pain).
PSEQ scores further put migraine pain in perspective with pain experienced with other pain conditions. Mean preoperative pain coping scores for migraine surgery candidates were 18.2 ± 11.7. This is a lower score than reported for severe chronic pain (average pain ≥7 for >6 months) with neuropathic character (26.4 ± 16.0), carpal tunnel syndrome (45 ± 12), fingertip fractures, amputations and lacerations (median PSEQ score, 54), chronic pain of the upper extremity such as arthritis (44 ± 15), and chronic back pain (36 to 44).16 , 29–37 By this comparison, the magnitude of debility in migraine surgery candidates becomes apparent.
Low PSEQ scores (<30) have been correlated with a high prevalence of long-term disability and depression in non–migraine-related disorders.25 Interestingly, although preoperative PSEQ scores were very low in migraine surgery patients, postoperative results were not worse with lower scores. On the contrary, improvement of PSEQ score after migraine surgery was higher than that seen in other pain conditions. Mean scores after migraine surgery improved by 112 percent. In comparison, chronic back pain patients after conservative therapy experienced an improvement in their score of 19 percent,33 and patients with finger injuries (e.g., amputations, lacerations, proximal interphalangeal joint dislocations) experienced an improvement between 2.6 and 7.4 percent.30 , 38 Partly, very low baseline scores in migraine surgery candidates and higher baseline scores in other pain conditions can explain a higher percentage improvement. However, it seems that migraine surgery patients can recover function and ability to cope with pain very well after surgery, in stark contrast to what has been shown in other pain conditions.
Overall, the PSEQ allows for evaluation of functional impairment in migraine surgery patients. It further significantly improves our understanding of pain in migraine surgery patients by comparison to other pain conditions. Because of these advantages, it should be considered as an outcome measure in migraine surgery patients. Recently, the short-form PSEQ-2 (two questions) was developed and validated, which would make it easy to include this measure in patient evaluation.39–41
In conclusion, we report continued positive outcomes after migraine surgery. Chronic pain questionnaires such as the PSEQ (or PSEQ-2) add to our understanding of functional outcome after surgery and put pain in migraine surgery patients in perspective with better known pain conditions.
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