Migraine surgery outcomes: An all or nothing phenomenon?
Lisa Gfrerer, MD PhD, William G. Austen, Jr., MD.
Massachusetts General Hospital, Boston, MA, USA.
PURPOSE: Traditionally, success/failure after migraine surgery is defined as improvement of migraine headache index (MHI) ≥50%, and ≤50%, respectively. However, our prospective data demonstrates more narrow binary outcomes. Patients either did not respond to surgery or improved completely. This study presents a detailed analysis of this surprising finding.METHODS: 42 subjects prospectively completed migraine questionnaires including MHI preoperatively, and 12 months postoperatively. RESULTS: All variables improved significantly from baseline (Table1). Outcomes were similar to prior studies with a success rate of 81%. Interestingly, 86% of patients improved MHI ≥80% or ≤ 5%. Only 14% fell between 5 and 80% (Figure 1). 69% of patients improved their MHI ≥ 80% with mean improvement of 97.1%. 16% of patients improved their MHI ≤ 5%, with an average improvement of 0%. CONCLUSION:Migraine surgery remains controversial. Others have argued that the etiology of migraine is more complex than nerve compression. This study again prospectively demonstrates the efficacy of surgical trigger site deactivation in migraine patients. It further shows that patients either fail or improve after surgery, with few intermediate outcomes. Such a binary distribution of outcome may point to a less complex etiology of pain such as peripheral nerve compression in these select patients.
|p value preop vs. postop|
|MHI total score[migraine headache (MHA)frequency x duration x pain severity]||122±97||32±58(-74%)||<0.00001|
|MHA frequency (days)||21±8.8||7.5±9.6||<0.00001|
|MHA pain(scale 0-10)||8.1±1.5||4.6±3.1||<0.00001|
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