Surgical Therapy Effective in Eliminating Migraines

Summary
In a recent study, the long term efficacy of surgical treatment for migraine headache was evaluated. This study was actually a continuation of the previous one-year study which included 125 participants, out of which 100 were surgically treated and 25 were grouped as controls. This prior study clearly showed that surgical therapy was very useful in eliminating the problem of migraine in some, while many others had very few symptoms of migraine linger. The present study was a follow-up of the same participants after their fifth year of surgical treatment.

Introduction
Migraines are very common in the U.S., affecting 18% of women and 6% of men. It leads to decreased job performance and missed workdays, resulting in a total annual loss of $14 million, and is significantly under-diagnosed and undertreated. Drugs that are used in the treatment of migraine are expensive and are associated with many side effects. Almost 33% of patients are never benefitted by any form of pharmaceutical therapy. Migraine patients have certain “triggers,” stimulation which provokes an attack of migraine. In surgical treatment, surgeons remove or destroy these trigger points. In their routine practice, researchers had observed that surgical treatment is nearly curative in many of the patients with migraines. They wanted to confirm their observation by doing a randomized control trial.

Methodology

  • In the first part of the study, 125 volunteers suffering from migraine were included in the study. Detailed neurological examination was done to confirm the diagnosis of migraine and also to identify the trigger points in each of them. 100 patients were grouped for surgical treatment, while 25 were taken as controls.
  • One year after the treatment, all the participants were asked to complete a questionnaire which included questions regarding various aspects of their symptoms, such as, frequency of pain, intensity of pain, and duration of pain. A product of all these was called a migraine index.
  • 17 of 25 controls underwent surgical treatment after the first part of study.
  • After five years (i.e. in the present study) a similar questionnaire was again given to all the participants, to assess migraine index.
  • Results

  • Out of 100 patients who were assigned to the surgical treatment group, 91 underwent successful surgery, and 89 were followed for one year. 79 of them were followed for five years.
  • The mean age of participants was 43.6 years and there were 6 men and 71 women.
  • The mean migraine index in surgically treated patients was 90.3 at the start of the study. At 5 years, it was just 11.4, indicating a decreased frequency, duration and severity of migraine headache.
  • 29% of surgically treated participants reported complete elimination of headache, whereas 59% reported significant reduction in headache.
  • Shortcomings
    Although rare, surgical treatment is associated with complications such as temporal nerve injury, neck stiffness, neck weakness, skin numbness, hypersensitivity, and hyposensitivity. Moreover, repeat surgeries are sometimes needed to eliminate the trigger points which are not identified at the initial stage. Apart from the trigger points which researchers have evaluated, there are other trigger points which are less common. Further studies should evaluate these trigger points as well, which may provide still more encouraging results. There was no control group to compare at the five year analysis, as most of them were surgically treated after the first year evaluation.

    Conclusion
    “This study not only confirms our findings from previous studies that the surgical treatment of migraine headaches in properly selected patients is likely to succeed but it also provides evidence that the obtained results are enduring.” In comparison to baseline values, 88% of the patients in the study showed that the results are both successful and lasting. The study also disproves that the placebo response effect is a significant factor in the outcomes and is a first in investigating the reasons that surgery might bring about migraine relief. The results point to a strong likelihood of surgical interventions causing a permanent decrease in intensity, frequency, and durations of migraines.

    For More Information:
    Five Year Outcome of Surgical Treatment of Migraine Headaches
    Plastic and Reconstructive Surgery Journal, February 2011
    By Bahman Guyuron, MD; Jennifer S. Kriegler, MD
    From the Case Western Reserve University and the Center for Headache and Pain, Cleveland Clinic, Cleveland, Ohio

    *FYI Living Lab Reports Are Summaries of the Original Research.
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