INTRODUCTION: Migraine headache is a very common disorder affecting 1.7%–4% of the world’s adult population. The first line therapy for these patients is usually a combination of conservative treatments. Despite this large variety of options available, some patients remain refractory. For such group, migraine surgery might offer a definitive solution for their medical condition. In these patients, migraine is usually caused by extracranial nerve compression due to vascular, fascial, or muscular structures nearby. The aim of migraine surgery is to relieve such compression at specific trigger points located in the occipital, temporal, and frontal regions.
MATERIALS AND METHODS: From June 2011 to December 2018, in our Plastic Surgery Unit at the University of Parma, Italy, we performed 235 surgical procedures for migraine in patients suffering from either frontal, occipital, or temporal headache.1–5 In patients with occipital and temporal migraine, nerve decompression was achieved by occipital and superficial temporal artery ligation, respectively. Vessels were previously localized by mean of portable Doppler device. In patients suffering from frontal headache, we performed nerve decompression with single-entry endoscopic myotomies of procerus, corrugator, and depressor supercilii muscles.
RESULTS: Among patient suffering from occipital migraine, 95% of them observed significant improvement of their condition, with 86% reporting complete relief. In temporal migraine, positive outcome was achieved in 83% of the patients (50% complete elimination and 33% partial improvement). In patient treated with endoscopic frontal myotomies, positive results were observed in 94% of the patients (32% complete elimination, 62% partial improvement).
CONCLUSIONS: Migraine is a common and debilitating condition that can be treated successfully with minimally invasive surgical procedures. We believe that vascular compression is the main causative agent in occipital and temporal migraine headache since the outstanding outcome that can be achieved by ligation only of occipital and superficial temporal artery, respectively. Frontal triggered migraine deactivation surgery still has fairly good outcomes but we feel that something is still missing and more researches should be performed.
1. Raposio E, Bertozzi N, Bordin C, et al. Surgical therapy of migraine and tension – type headaches. In: Turker H, ed. Current Perspectives on Less-known Aspects of Headache. InTech; 2017. doi:10.5772/64652.
2. Caruana G, Bertozzi N, Boschi E, et al. Endoscopic forehead surgery for migraine therapy: personal technique. Ann Ital Chir. 2014;85:583–586.
3. Raposio E, Caruana G. Tips for the surgical treatment of occipital nerve-triggered headaches. Eur J Plast Surg. 2016:1–6. doi: 10.1007/s00238-016-1249-8.
4. Raposio E, Caruana G. Minimally invasive endoscopic surgical treatment of headache. In: Raposio E, ed. Atlas of Endoscopic Plastic Surgery. 1st ed. New York, N.Y.: Springer; 2015:17–23.
5. Polotto S, Simonacci F, Grignaffini E, et al. Surgical treatment of frontal and occipital migraines: a comparison of results. Plast Reconstr Surg Glob Open. 2016;14:e653.