Migraine Surgery Produces Dramatic Functional Improvements

A new study claims that in addition to reducing headache frequency and severity, surgical treatment for migraine leads to significant improvements in everyday functioning and coping ability.

The study, by researchers at Harvard Medical School (HMS; Boston, MA, USA), Massachusetts General Hospital (MGH; Boston, USA), and Academic Medical Center (AMC; Amsterdam, The Netherlands) prospectively enrolled 90 migraine patients who underwent surgery and completed the Migraine Headache Index (MHI) and pain self-efficacy questionnaire (PSEQ) preoperatively and at 12 months postoperatively. The final analysis included 74 patients who completed both questionnaires at one-year follow-up.

The results revealed that preoperative pain coping scores in migraine patients were substantially lower than those of patients with other types of chronic pain, such as neuropathic, arthritis, or lower back pain. All scores improved significantly from baseline; while average preoperative PSEQ score was 18.2, the improvement following migraine surgery was 112%, higher than that seen in other pain conditions. Preoperative PSEQ scores did not influence postoperative outcome. The study was published in the January 2018 issue of Plastic and Reconstructive Surgery.

“The PSEQ successfully demonstrates the extent of debility in migraine surgery patients by putting migraine pain in perspective with other known pain conditions,” concluded senior author William Gerald Austen, Jr, MD, of MGH. “It further evaluates functional status, rather than improvement in migraine characteristics, which significantly adds to our understanding of outcome. Poor preoperative PSEQ scores do not influence outcome, and should not be used to determine eligibility for migraine surgery.”

Migraine surgery involves deactivation of certain trigger points by surgical decompression of the peripheral sensory nerves around the skull. The outpatient procedure is performed under local or general anesthesia and usually takes one to two hours. Some patients have multiple migraine trigger points on different areas of the head, and surgery may therefore take longer.

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Harvard Medical School
Massachusetts General Hospital
Academic Medical Center