433 Efficacy and Safety of Surgical Decompression for Migraine: A Systematic Review

Abstract

INTRODUCTION: Migraine is a common disabling disease with high socioeconomic and personal impacts. Despite various medical options, many patients suffer refractory and chronic migraines. New surgical approaches are gaining traction as viable options to treat migraines. METHODS: The study was conducted in accordance with PRISMA guidelines. An inclusive search of several databases from January 1990 to December 2nd, 2020, was performed. Studies reporting various decompression approaches of peripheral nerves for chronic or refractory migraines were included and analyzed. The risk of bias of individual studies was assessed in accordance with the modified Newcastle-Ottawa Quality Assessment Scale. Only those studies representing their data of migraine with mean frequency and intensity of headache, as well as their complication event rate, were reported. RESULTS: Total, 22 studies comprising 1377 patients with migraines were included. Mean age of patients undergoing surgery was 44.22 (95% CI 42.96 - 45.48) years. Patients underwent surgery for migraine comprising decompression of supraorbital, supratrochlear, zygomaticotemporal, or occipital nerve. Most studies reported recovery from headache with improvement in mean headache frequency (range 4.4 to 16.6 days per month) and mean headache intensity (range 2.80 to 7.30 in visual analog scale). The risk of bias was high, with the bias being high in 10 studies and moderate in 11 studies. Total complication rate was 8.0% (95% CI 4.0%-13.0%) which included paresthesia, wound infection, and hypertrophic scarring in a follow-up duration of 2 to 66 months. Heterogeneity in outcome measures and moderate-to-high risk of bias in the majority of studies precluded for meta-analysis. CONCLUSION: Despite improvement in headache frequency and intensity reported on surgical decompression for migraine, available studies reported used variable outcome measures and had moderate-to-high risk of bias.