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A Pain in the Neck? Migraine Surgery in Patients With Prior Head or Neck Injury

Ortiz, Ricardo BSc; Gfrerer, Lisa MD, PhD; Hansdorfer, Marek A. MD; Tsui, Jane MD; Nealon, Kassandra P. BSc; Austen, William G. Jr MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 59-60
doi: 10.1097/01.GOX.0000584548.33411.bf
Craniofacial Abstracts
Open

Massachusetts General Hospital, Harvard Medical School, Boston, MA

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: A high prevalence (≈37%) of prior head and neck injury has been reported in patients undergoing migraine headache (MH) surgery.1 Conservative medical treatment of posttraumatic MH has had limited success. It is unclear if MH surgery mirrors these unsatisfactory outcomes. In an effort to improve patient selection and preoperative counseling for MH surgery, it is critical to understand expected outcomes across specific populations, including the posttraumatic cohort. However, this subgroup has not been described in detail and their outcomes have not been compared to patients without a history of head or neck injury.

METHODS AND MATERIALS: One hundred forty-two subjects undergoing migraine surgery were prospectively enrolled. Preoperatively, patients were asked to complete a questionnaire on MH history, including the MH index (MHI) and information on prior head or neck injury. This included data on the nature of the injury, timing in relation to their MH, and whether they attributed their MH pain to the injury itself (precipitating event). The senior author performed all surgical procedures. Follow-up surveys were sent to all patients at 12 months postoperatively.

RESULTS: Of the subjects included in this study, 50% (n = 71) reported a history of head or neck injury, and 30% (n = 42) classified the injury as the precipitating event leading to their MH. Patients who associated their injury with the onset of their MH were significantly less likely to have a positive family history of MH. There was no significant difference in mean preoperative MHI among the atraumatic (108.8 ± 80.0), traumatic (99.9 ± 92.5), and precipitating event (90.8 ± 90.1) cohorts. At 12 months postoperatively, there was no significant difference in MHI reduction between these 3 groups. The proportion of patients who experienced at least a 50% and 80% improvement in MHI per group, respectively, was 83% and 67% (atraumatic), 76% and 68% (traumatic) (P = 0.40), and 71% and 63% (precipitating event). The median follow-up time was 12.9 months (interquartile range, 11.8–15.2).

CONCLUSIONS: Fifty percent of patients undergoing migraine surgery at our center report a history of head and neck injury. This finding corroborates a higher prevalence of head and neck injury in patients with migraine as compared to the general population.2 Further, this study suggests that outcomes in migraine surgery patients with a prior history of head and neck injury are comparable to those without injury. Migraine surgery candidates with a history of injury can therefore expect similar outcomes as reported for migraine surgery patients overall.

REFERENCES:

1. Janis JE, Dhanik A, Howard JH. Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression. Plast Reconstr Surg. 2011;128:123–131.

2. Couch JR, Lipton RB, Stewart WF, et al. Head or neck injury increases the risk of chronic daily headache: a population-based study. Neurology. 2007;69:1169–1177.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.