Minimally Invasive Surgical Treatment of Migraine

Francesco Simonacci,Edoardo Raposio,Nicolò Bertozzi,Carlo Fante,Gianluigi Lago,Giuseppe Sanese

doi:10.5772/intechopen.90285

Abstract

Migraine headache (MH) is a very common disorder affecting 10–12% of the world’s adult population. The first line therapy for migraine is usually a combination of conservative treatments but some patients seem to be refractory. For this group of patients, the minimally invasive surgical treatment of migraine might offer a solution. Migraine is usually caused by extracranial sensitive nerve compression due vascular, fascial or muscular structures nearby. The aim of migraine surgery is to relieve such compression at specific trigger points located in the occipital, temporal and frontal regions. From June 2011 until July 2019, we performed MH decompression surgeries in over 269 patients with either frontal, occipital, or temporal migraine trigger sites. In the occipital and temporal areas, nerve decompression was achieved by occipital and superficial temporal artery ligation, respectively. In patients suffering from frontal headache we performed both endoscopic nerve decompression and transpalpebral decompression. Among patient suffering from occipital migraine, 95% of them showed improvement of their condition, with 86% reporting complete relief. As concern temporal migraine, positive outcome was achieved in 83% of the patients (50% complete elimination and 33% partial improvement). In patient suffering from frontal migraine, positive results were observed in 94% of the patients (32% complete elimination, 62% partial improvement). Migraine is a common and debilitating condition that can be treated successfully with minimally invasive surgical procedure especially for those patients non-responding to medical therapies.

Highlights

Migraine headache (MH) is known to affect over 324.1 million people worldwide [1, 2]
In order to lift the frontal skin during the endoscopic procedure nylon 1-0 sutures were placed in the superciliary region at each side of both supratrochlear and supraorbital nerves bilaterally
According to Guyuron et al [7], Lin et al [23], Dash et al [24], and Lee et al [25], the currently adopted procedure for treatment of the occipital trigger site, undertaken under general anesthesia, relies first on an incision in the occipital scalp and extensive undermining through which a small portion of the semispinalis capitis muscle is removed. This muscle is usually pierced by the greater occipital nerve (GON), lesser occipital nerves (LON) bilaterally

Summary

Introduction

Migraine headache (MH) is known to affect over 324.1 million people worldwide [1, 2]. Independent researchers demonstrated the efficacy of botulin toxin injection for the treatment of MH [2] These evidences supported the hypothesis that MH was determined by the peripheral activation of trigeminal nerve branches. 3. III Trigger Site (Rhinogenic): patients complain of paranasal and retrobulbar headaches; deviated septum, contact between the turbinates and the septum, concha bullosa, septa bullosa, and other intranasal abnormalities may irritate the trigeminal end branches. IV Trigger Site (Occipital): patients refer occipital symptoms: occipitalis, trapezius, and semispinalis capitis muscles, fascial bands, or the occipital artery can irritate the greater occipital nerve (GON) and/or the lesser occipital nerve (LON) Following these evidences, it came to be clearly known that an essential step was detecting the precise site of pain onset (the trigger point) [2, 10–12]. Rigorous patient screening and selection with proper identification of MH trigger points are mandatory for a successful surgical outcome; yet a thorough understanding of the anatomy is essential to ensure complete nerve release and prevent postoperative complications

Surgical treatment

Frontal trigger site

Temporal trigger site

Results

Complications