Vascular surgery for chronic migraine

Abstract

Background: The superficial branches of the external carotid artery have been shown to be the origin of headache pain in some individuals. Surgical ligation of the temporal artery was first described by Al Zahrawi. Since then, excellent results have been achieved surgically in those patients in whom the superficial vessels have been positively identified as the source of the headache pain. Aim: To determine the improvement in quality of life in patients suffering from chronic daily headache (CDH) following cauterization of superficial scalp vessels. Patients & methods: In total, 65 patients with CDH, in whom the superficial scalp vessels were positively identified as the source of pain, underwent surgical cauterization of the relevant vessels. Results: The quality of life of CDH sufferers in whom the pain was shown to originate in the superficial scalp vessels was significantly improved following surgical cauterization of the relevant vessels. Conclusion: Surgical cauterization of superficial scalp vessels can be a valuable treatment modality in selected patients with CDH. The extracranial branches of the external carotid artery are an important source of pain in some patients with primary headaches [1–16]. In these patients, surgical cauterization of the relevant arteries provides permanent pain relief [17–26]. Chronic daily headache (CDH) refers to headaches that occur for 15 or more days per month. Chronic migraine (CM) is a form of CDH in which patients develop a pattern of daily or near-daily headaches that have features of both migraine and tension-type headache. Most patients with this disorder are women with a past history of episodic migraine without aura, whose attacks have become more frequent over the years. The associated symptoms of photophobia, phonophobia, nausea and vomiting, frequently become less severe and less common [27–30]. In this study, the quality of life (QOL) of patients with CM was measured before surgical cauterization of superficial scalp vessels, and again 1 year later. The purpose was to ascertain the effect of this form of treatment on the QOL of people suffering from CM and in whom the superficial scalp vessels were positively identified as the source of pain by a compression maneuver.