Two Migraine Surgeries Provide Significant Pain Reduction

Patients who suffer from migraine headaches may find relief in the severity, frequency, and duration with the help of 2 procedures.

After Bahman Guyuron, MD, witnessed patients with migraine experiencing less headache activity following cosmetic forehead lift surgeries, he developed procedures to target particulartrigger sites. Along with his colleagues from the School of Medicine at Case Western Reserve University, Guyuron reported the positive outcomes of the surgeries and how they can be used to treat painful headaches.

“Surgical techniques involve decompression or ablation of irritated nerves at multiple distinct trigger sites,” the authors wrote in Plastic and Reconstructive Surgery. “The four most common sites are frontal, temporal, nasal, and occipital.”

The team looked at the temporal-based migraines, which is in the top 2 most common trigger sites. A total of 19 patients with bilateral temporal migraines — determined by symptoms, nerve blocks, ultrasound Doppler, and CT scans – participated in the study between January 2011 and August 2012. The participants consisted of 18 females andhad an average age of 38.2. They experienced at least 4 moderate to severe migraines per month lasting between 4 and 72 hours with a pain rate of at least 5 out of 10 even with medication.

The zygomaticotemporal branch of the trigeminal nerve (ZTBTN) is associated with temporal migraines and was therefore the target in both procedures. The patients were randomly assigned to undergo neurectomy of the ZTBTN on one side of the head and decompression of the nerve on the other. Follow-ups took place on day one, day 30, and every 3 months for one year. A detailed migraine form was used for evaluation every 3 months and the Migraine Disability Assessment questionnaire was completed one year following the surgery.

“When each variable was analyzed and compared with the preoperative values, patients with temporal trigger sites observed considerable improvement in their symptoms with surgical treatment,” Guyuron and team explained.

The results revealed that 89% of the patients had 50% improvement in the number of migraine days as well as the frequency, severity, and duration of the headaches — 10.5% of patients did not reach the 50% improvement level. In addition, 55% were totally free of headache symptoms at the one-year mark. However, the study noted that 3 patients did not experience significant improvement bilaterally and 2 did not show clinical improvement at just the decompression site.

A news release on the trial verified that 5 independent centers affirmed the findings.

“Both avulsion neurectomy and decompression of the zygomaticotemporal branch of the trigeminal nerve are equally effective methods for the treatment of temporal migraine headache,” the team confirmed.