Nerve Surgery Improves Frontal Migraine Symptoms, Study Finds

Surgical decompression of supraorbital and supratrochlear nerves may aid migraineurs experiencing moderate to severe chronic frontal migraine who do not respond to medications, according to a study published in Plastic and Reconstructive Surgery (PRS) Global Open.

Migraine affects roughly 1.7% to 4% of the world’s population, and the first approach to treating migraine headache is typically “a combination of pharmacologic treatments (both abortive and preventive drugs) and nonpharmacologic interventions like behavioral and lifestyle changes.”

Although the pathophysiology of migraine is unknown, “it is a common belief that chronic compression to the terminal branches of trigeminal nerve caused by surrounding structures (muscles, vessels, or fascial bands) is responsible for its origin,” researchers said.

As many migraineurs do not adequately respond to pharmacological treatments, investigators carried out an alternative, minimally invasive procedure to decompress supraorbital and supratrochlear nerves in patients.

In total, 259 migraine headache decompression surgeries were performed on patients with frontal, occipital, or temporal migraine trigger sites between June 2011 and May 2019. Of the procedures, 70 frontal migraine decompression surgeries were performed on 56 women and 14 men with an average age of 49.5 years. Sixty-five of the surgeries were bilateral while 5 were unilateral, and 68 patients underwent an endoscopic surgical approach. The remaining 2 patients underwent a transpalpebral approach.

Migraineurs also completed a comprehensive headache questionnaire before surgery, while the Migraine Disability Assessment scale was used to evaluate each patient’s degree of disability.

After a mean 24-month follow-up period, researchers found individuals with frontal trigger site migraine exhibited a 94% positive response to surgery. Specifically:

• 32% reported complete relief
• 62% reported significant improvement, intended as over 50% reduction in duration, frequency, and intensity of headache
• 6% had no change in their symptoms

Among all patients who underwent migraine headache frontal decompression surgeries, “24 patients (34.2%) experienced secondary trigger point emergence following primary occipital and/or temporal migraine surgery.” Twenty of these patients reported 2 trigger points and 4 reported all 3 trigger points (frontal, occipital, temporal). However, “all patients continue to experience a quality of life better than before surgery, and all would have the surgery again,” authors note.

Anesthesia from the procedure occurred in almost all patients and lasted an average of 163 days post surgery. Minor complications reported by patients following surgery were lasting intense itching (5.7%), hypertrophic scar (2.7%), incisional cellulitis (1%), and transient mild incisional alopecia or hair thinning (5%).

The positive outcomes from surgical deactivation of peripheral sensory nerves can lead to cost savings by reducing expenses incurred from medications, doctor visits, and other migraine headache financial burdens, authors conclude.

Reference

Raposio E, Simonacci F. Frontal trigger site deactivation for migraine surgical therapy. Plast Reconstr Surg Glob Open. Published online April 29, 2020. doi:10.1097/GOX.0000000000002813