Migraine Headache Index Research Articles

Estrogen-Associated Headaches Can Be Treated by Surgery: A Multicenter Retrospective Cohort Study.

Nerve decompression surgery has been successful in treating headaches refractory to traditional medical therapies. Nevertheless, a subset of patients remains unresponsive to surgical treatment. The authors conducted a retrospective chart review of the two senior authors' (J.E.J. and W.G.A.) patient data from 2007 to 2020 to investigate differences in surgical outcomes in women reporting estrogen-associated headaches (headaches associated with menstrual period, oral contraceptives, pregnancy, or other hormonal drugs) compared with those who did not. For these two groups, the authors used the migraine headache index as the metric for headache severity and compared the mean percent change in migraine headache index score at 3 months and 1 year. Of the 99 female patients who underwent nerve decompression surgery and met inclusion criteria, 50 reported estrogen-associated headaches and were found to have significantly earlier age of onset ( p = 0.017) and initial presentation to clinic ( p = 0.046). At 1 year postoperatively, migraine headache index score had improved more than 80 percent in the majority of patients (67 percent), but there was a subset of patients whose score improved less than 5 percent (12.5 percent). The authors did not find a significant difference in percent change in postoperative migraine headache index score between women with estrogen-associated headaches and those without such headaches. Women with estrogen-associated headaches have surgical outcomes comparable to those of women without this association. Nerve decompression surgery should be offered to women experiencing estrogen-associated headaches as an option for treatment. Risk, II.

The beneficial effect of Alpha-lipoic acid supplementation as a potential adjunct treatment in episodic migraines

The current study was performed to evaluate the effects of alpha-lipoic acid (ALA) supplementation on lactate, nitric oxide (NO), vascular cell adhesion molecule-1 (VCAM-1) levels, and clinical symptoms in women with episodic migraines. Considering the inclusion and exclusion criteria, ninety-two women with episodic migraines participated in this randomized, double-blind, placebo-controlled, parallel-design trial. The participants were randomly assigned to receive either 300 mg/day ALA or placebo, twice per day for 12 weeks. The primary outcomes included headache severity, headache frequency per month, and duration of attacks and the secondary outcomes included lactate (a marker of mitochondrial function), NO, and VCAM-1 serum levels were measured at baseline and the end of the intervention. At the end of the study, there was a significant decrease in lactate serum levels (− 6.45 ± 0.82 mg/dl vs − 2.27 ± 1.17 mg/dl; P = 0.039) and VCAM-1 (− 2.02 ± 0.30 ng/ml vs − 1.21 ± 0.36 ng/ml; P = 0.025) in the ALA as compared to the placebo group. In addition, the severity (P < 0.001), frequency (P = 0.001), headache impact test (HIT-6) (P < 0.001), headache dairy results (HDR) (P = 0.003), and migraine headache index score (MHIS) (P < 0.001) had significantly decreased in the intervention as compared to the control group. No significant changes were observed for NO levels and duration of migraine pains. ALA supplementation can be considered a potential adjunct treatment in patients with migraine due to its improving mitochondrial and endothelial functions and clinical symptoms.

Outcomes of Surgical Treatment of Migraines: A Systematic Review & Meta-Analysis.

Background: Migraine surgery at 1 of 6 identified "trigger sites" of a target cranial sensory nerve has rapidly grown in popularity since 2000. This study summarizes the effect of migraine surgery on headache severity, headache frequency, and the migraine headache index score which is derived by multiplying migraine severity, frequency, and duration. Materials and Methods: This is a PRISMA-compliant systematic review of 5 databases searched from inception through May 2020 and is registered under the PROSPERO ID: CRD42020197085. Clinical trials treating headaches with surgery were included. Risk of bias was assessed in randomized controlled trials. Meta-analyses were performed on outcomes using a random effects model to determine the pooled mean change from baseline and when possible, to compare treatment to control. Results: 18 studies met criteria including 6 randomized controlled trials, 1 controlled clinical trial, and 11 uncontrolled clinical trials treated 1143 patients with pathologies including migraine, occipital migraine, frontal migraine, occipital nerve triggered headache, frontal headache, occipital neuralgia, and cervicogenic headache. Migraine surgery reduced headache frequency at 1 year postoperative by 13.0 days per month as compared to baseline (I2 = 0%), reduced headache severity at 8 weeks to 5 years postoperative by 4.16 points on a 0 to 10 scale as compared to baseline (I2 = 53%), and reduced migraine headache index at 1 to 5 years postoperative by 83.1 points as compared to baseline (I2 = 2%). These meta-analyses are limited by a small number of studies that could be analyzed, including studies with high risk of bias. Conclusion: Migraine surgery provided a clinically and statistically significant reduction in headache frequency, severity, and migraine headache index scores. Additional studies, including randomized controlled trials with low risk-of-bias should be performed to improve the precision of the outcome improvements.

Associations between adherence to Mediterranean dietary pattern and frequency, duration, and severity of migraine headache: A cross-sectional study

ABSTRACT Background The present study was conducted to explore the association between adherence to Mediterranean dietary pattern and migraine headache features including frequency, duration, and severity, as well as patients’ migraine-related disabilities among the Iranian population diagnosed with migraine. Methods In the present cross-sectional study on 262 migraine patients aged 20-50 years old, a validated 168-item, food frequency questionnaire was used to assess the dietary intakes of participants. The Mediterranean diet score was calculated for each subject using nine pre-defined dietary components and ranged from 0-9. The headache severity, duration, frequency, migraine headache index score (MHIS), and headache impact test-6 (HIT-6) were measured using related questionnaires. Results After controlling for potential confounders, Mediterranean diet tended to be associated with lower headache frequency (β = −1.74, 95% CI: −3.53,0.03) and duration (β = −0.28, 95% CI: −0.59, −0.02) and was significantly associated with lower MHIS (β = −29.32, 95% CI: −51.22, −7.42), and HIT-6 score (β = −2.86, 95% CI: −5.40, −0.32) for those in the highest category of Mediterranean diet scores compared to the lowest category. A subgroup analysis of women also revealed a negative association between Mediterranean diet and headaches frequency (β = −2.30, 95% CI: −4.27, −0.32), duration (β = −0.42, 95% CI: −0.78, −0.07), scores of MHIS (β = −47.44, 95% CI: −71.90, −22.99), and HIT-6 (β = −3.45, 95% CI: −6.29, −0.61), after controlling for potential confounders. Conclusions The present study suggests that adherence to the Mediterranean dietary pattern is associated with lower headache frequency, duration, MHIS, and HIT-6 score.

Clinical Effectiveness of Peripheral Nerve Blocks for Diagnosis of Migraine Trigger Points.

With a 13 percent global prevalence, migraine headaches are the most commonly diagnosed neurologic disorder, and are a top five cause of visits to the emergency room. Surgical techniques, such as decompression and/or ablation of neurovasculature, have shown to provide relief. Popular diagnostic modalities to identify trigger loci include handheld Doppler examinations and botulinum toxin injection. This article aims to establish the positive predictive value of peripheral nerve blocks for identifying therapeutic surgical targets for migraine headache surgery. Electronic medical records of 36 patients were analyzed retrospectively. Patients underwent peripheral nerve blocks using 1% lidocaine with epinephrine and subsequent surgery on identified migraine headache trigger sites. Patients were grouped into successful and unsuccessful blocks and further categorized into successful and unsuccessful surgery subgroups. Group analysis was performed using paired t tests, and positive-predictive value calculations were performed on subgroups. The preoperative Migraine Headache Index of patients with positive blocks was 152.71, versus 34.26 postoperatively (p < 0.001). Each index component also decreased significantly: frequency (22.11 versus 15.06 migraine headaches per month; p < 0.001), intensity (7.43 versus 4.12; p < 0.001), and duration (0.93 versus 0.55 days; p < 0.001). The positive-predictive value of diagnostic peripheral nerve blocks in identifying a migraine headache trigger site responsive to surgical intervention was calculated to be 0.89 (95 percent CI, 1 to 0.74). To the authors' knowledge, this is the first study to investigate the positive-predictive value of peripheral nerve blocks as used in the diagnostic workup of patients with chronic migraine headaches. Peripheral nerve blocks serve as a reliable clinical tool in mapping migraine trigger sites for surgical intervention while offering more flexibility in their administration and recording as compared to established diagnostic methods. . Diagnostic, IV.

The Relationship of Psychiatric Comorbidities and Their Impact on Trigger Site Deactivation Surgery for Headaches.

Patients seeking trigger site deactivation surgery for headaches often have debilitating symptoms that can affect their functional and mental health. Although prior studies have shown a strong correlation between psychiatric variables and chronic headaches, their associations in patients undergoing surgery have not been fully elucidated. This study aims to analyze psychiatric comorbidities and their impact on patients undergoing trigger site deactivation surgery for headaches. One hundred forty-two patients were prospectively enrolled. Patients were asked to complete the Patient Health Questionnaire-2 and Migraine Headache Index surveys preoperatively and at 12 months postoperatively. Data on psychiatric comorbidities were collected by means of both survey and retrospective chart review. Preoperatively, 38 percent of patients self-reported a diagnosis of depression, and 45 percent of patients met Patient Health Questionnaire-2 criteria for likely major depressive disorder (Patient Health Questionnaire-2 score of ≥3). Twenty-seven percent of patients reported a diagnosis of generalized anxiety disorder. Patients with depression and anxiety reported more severe headache symptoms at baseline. At 1 year postoperatively, patients with these conditions had successful surgical outcomes comparable to those of patients without these conditions. Patients also reported a significant decrease in their Patient Health Questionnaire-2 score, with 22 percent of patients meeting criteria suggestive of depression, compared to 45 percent preoperatively. There is a high prevalence of depression and anxiety in patients undergoing trigger site deactivation surgery. Patients with these comorbid conditions achieve successful surgical outcomes comparable to those of the general surgical headache population. Furthermore, trigger site deactivation surgery is associated with a significant decrease in depressive symptoms.

The effects of synbiotic supplementation on oxidative stress and clinical symptoms in women with migraine: A double‐blind, placebo‐controlled, randomized trial

Oxidative stress may play an important role in migraine pathogenesis. This randomized controlled trial aimed to investigate the effect of 12 weeks synbiotic supplementation on the oxidative stress and clinical symptoms of migraine in eighty women. The effect of the intervention on the total antioxidant capacity (TAC), nitric oxide (NO), oxidative stress index (OSI), total oxidant status (TOS), migraine index (MI), headache diary result (HDR) and migraine headache index score (MHIS) were investigated using bivariate comparison. Synbiotic supplementation improved TAC (381.77 vs 43.17 nmol/ml, P = 0.034), and reduced NO (-4.62 vs 0.55 nmol/ml, P = 0.021), OSI levels (-0.33 vs 0.0009, P = 0.027), and MI (-8.27 vs −3.20, P = 0.013) compared to placebo. A positive correlation between the severity of migraine headache and NO level was observed following synbiotic supplementation (r = 0.44, P = 0.002). Synbiotics may reduce oxidative stress and improve migraine symptoms in women and help as a supplemental therapy in managing migraine headaches.

Is there a relationship between dietary sodium and potassium intake and clinical findings of a migraine headache?

Few studies have assessed the association between sodium (Na) and potassium (K) and migraine headaches. In this study, we aimed to examine the relationship between 24-hour urine Na and K intakes and clinical findings of migraine in an Iranian sample. In this cross-sectional study, 262 participants, aged 20-50 years, were included with a body mass index (BMI) of 18·5-30 kg/m2and a diagnosis of migraine. One 24-hour urine sample was collected from each subject to estimate the Na and K intakes. The clinical features of migraine, including frequency, duration, severity, Migraine Headache Index Score (MHIS), and Headache Impact Test (HIT) score, were assessed. Besides, a multiple linear regression analysis was performed, and beta estimates and the corresponding 95% confidence intervals (CIs) were reported. Overall, 224 women and 38 men, with a mean age of 36·10 years and BMI of 25·55 kg/m2 comprised our study population. After controlling for potential confounders, the 24-hour urine Na was positively associated with a longer headache duration (β = 0·29; 95% CI: 0·06, 0·53) in the group with the highest urine Na levels as compared to the group with the lowest levels. After adjustments for potential confounders, an increase of 13·05 in the MHIS was observed when the 24-hour urine Na level increased from the first to the third tertile (β = 13·05; 95% CI: 1·70, 24·41). Our findings suggested that a higher 24-hour urine Na level was positively associated with a longer duration of migraine headaches and a higher MHIS.

Efficacy and Safety of Migraine Surgery: A Systematic Review and Meta-analysis of Outcomes and Complication Rates.

The objectives of this study are to assess the efficacy and safety of peripheral nerve surgery for migraine headaches and to bibliometrically analyze all anatomical studies relevant to migraine surgery. Migraines rank as the second leading cause of disability worldwide. Despite the availability of conservative management options, individuals suffer from refractive migraines which are associated with poor quality of life. Migraine surgery, defined as the peripheral nerve decompression/trigger site deactivation, is a relatively novel treatment strategy for refractory migraines. EMBASE and the National Library of Medicine (PubMed) were systematically searched for relevant articles according to the PRISMA guidelines. Data was extracted from studies which met the inclusion criteria. Pooled analyses were performed to assess complication rates. Meta-analyses were run using the random effects model for overall effects and within subgroup fixed-effect models were used. A total of 68 studies (38 clinical, 30 anatomical) were included in this review. There was a significant overall reduction in migraine intensity (P < 0.001, SE = 0.22, I2 = 97.9), frequency (P < 0.001, SE = 0.17, I2 = 97.7), duration (P < 0.001, SE = 0.15, I2 = 97), and migraine headache index (MHI, P < 0.001, SE = 0.19, I2 = 97.2) at follow-up. A total of 35 studies reported on migraine improvement (range: 68.3%-100% of participants) and migraine elimination (range: 8.3%-86.5% of participants). 32.1% of participants in the clinical studies reported complications for which the most commonly reported complications being paresthesia and numbness, which was mostly transient, (12.11%) and itching (4.89%). This study demonstrates improved migraine outcomes and an overall decrease in MHI as well as strong evidence for the safety profile and complication rate of migraine surgery.

The effects of the dietary approaches to stop hypertension (DASH) diet on oxidative stress and clinical indices of migraine patients: a randomized controlled trial

ABSTRACT Aims The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and oxidative stress (OS) in patients diagnosed with migraine is unknown and remains to be examined. Hence, we conducted a parallel-group, randomized controlled trial to investigate this issue. Methods Of the 102 women who met all the inclusion criteria, 51 individuals were randomized to the DASH diet group and 51 to the usual dietary advice group to receive allocated intervention for three months. In order to assess the compliance of participants to the DASH diet, dietary records, and serum vitamin C levels were examined. Parameters of OS status (e.g. nitric oxide (NO), total antioxidant capacity (TAC), total oxidative status (TOS), malondialdehyde (MDA), and oxidative stress index (OSI)) and clinical indices of migraine (e.g. migraine index (MI), headache dairy result (HDR), and migraine headache index score (MHIS)) were assessed at the beginning and the end of the study. Results There was a significant reduction in NO (–5.75 vs. + 4.18, P = 0.025) and TOS (–1.55 vs. + 0.71, P = 0.034), and a marginally significant reduction in OSI (-0.10 vs. + 0.14, P = 0.060) in the DASH group compared with the control. Compliance with the DASH diet resulted in a significant decrease in the score of MI (–31.33 vs. – 15.09), HDR (–5.04 vs. –2.51), and MHIS (–44.21 vs. –26.74). Moreover, no significant change was observed in TAC, MDA, and total thiol content. Conclusion This type of dietary approach can be considered as a complementary treatment for migraine patients, also further investigations are needed to replicate our findings. Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20121216011763N38.

Spotlight in Plastic Surgery: April 2021.

Spotlight in Plastic Surgery: April 2021.

Selective denervation of the corrugator supercilii muscle for the treatment of idiopatic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and suprathrochlear dermatomes

IntroductionIdiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs. Based on the study of the motor innervation of the CSM, we describe here an alternative approach to improve these type of migraines, based on a minimally invasive denervation of the CSM.Materials and methodsMotor innervation and feasibility of selective CSM denervation was first studied on fresh frozen cadavers. Once the technique was safely established, 15 patients were enrolled. To be considered eligible, patients had to meet the following criteria: positive response to BTA treatment, migraine disability assessment score > 24, > 15 migraine days/month, no occipital/temporal trigger points and plausible reasons to discontinue BTA treatment. Pre- and post- operative migraine headache index (MHI) were compared, and complications were classified following the Clavien-Dindo classification (CDC).ResultsFifteen patients (9 females and 6 males) underwent the described surgical procedure. The mean age was 41 ± 10 years. Migraine headache episodes decreased from 24 ± 4 day/month to 2 ± 2 (p < 0.001) The MHI decreased from 208 ± 35 to 10 ± 11 (p < 0.001). One patient (7%) had a grade I complication according to the CDC. No patient needed a second operative procedure.ConclusionsOur findings suggest that the selective CSM denervation represents a safe and minimally invasive approach to improve ITNp distributed in the SSd associated with CSM hyperactivation.Trial registrationThe data collection was conducted as a retrospective quality assessment study and all procedures were performed in accordance with the ethical standards of the national research committee and the 1964 Helsinki Declaration and its later amendments.

Comparison of Peripheral Neurectomy vs. Medical Treatment for Migraine: A Randomized Controlled Trial.

Migraine is a common form of primary neurologic headache. Many patients are chronic migraineurs and suffer from a significant disability and adverse effects of drugs. There are various surgical options available to treat migraines, including peripheral neurectomies. To study the surgical and functional outcomes of migraine surgeries using peripheral neurectomies and compare them with conservatively treated patients. Migraine patients who had a unilateral onset pain were given local bupivacaine block at the suspected trigger site, and those who were relieved were given the option for surgery. In the operative group, the peripheral nerve of the trigger site was lysed under local anesthesia. The conservative group was continued with the standard treatment. Evaluations with a baseline and 6 months visual analog score (VAS), migraine headache index (MHI), migraine disability assessment test (MIDAS), and pain self-efficacy questionnaire (PSEQ) scores were done. A total of 26 patients got benefitted with the local bupivacaine block, out of which 13 underwent surgery. At baseline, the VAS, MHI, MIDAS, and PSEQ scores were similar in both the groups. The operative group had significant (P < 0.001) improvement in all these parameters 6 months after the surgery. All patients of the operative group got free from prophylactic migraine treatment; however, 11 out of 13 patients still needed occasional use of analgesics. There was one complication of transient temporal numbness. Migraine surgery using peripheral neurectomies was more effective than chronic drug treatment in appropriately selected patients.

Clinical Effectiveness of Peripheral Nerve Blocks for Diagnosis of Migraine Trigger Points

BACKGROUND: With a 13% global prevalence, migraine headaches (MH) are the most commonly diagnosed neurologic disorder and are a top 5 cause of visits to the emergency room. Surgical techniques—such as decompression and/or ablation of neurovasculature—have shown to provide relief in patients suffering from MH. Popular diagnostic modalities to identify trigger loci include handheld doppler exams and botulinum toxin injection. This article aims to establish the positive predictive value (PPV) of peripheral nerve blocks for identifying therapeutic surgical targets for MH surgery. METHODS: Charts of 36 patients were retrospectively analyzed. These patients underwent peripheral nerve blocks using 1% lidocaine with epinephrine and subsequent surgery on identified MH trigger points. Patients were grouped into successful and unsuccessful blocks and further categorized into successful and unsuccessful surgery subgroups. Group analysis was done using paired t tests and PPV calculations were done on subgroups. RESULTS: Mean postsurgical follow-up was 11.5 months. Prior to surgery, Migraine headache index of patients was 168.16 versus 43.69 after surgery (P < 0.001). Each of the components of Migraine headache index also significantly decreased: frequency (24.54 MH/mo versus 8.53; P < 0.001), intensity (7.33 versus 4.75; P < 0.001), and duration (0.8 days versus 0.39; P < 0.001). The PPV of diagnostic peripheral nerve blocks in identifying a MH trigger point responsive to surgical intervention was calculated to be 0.89 (95% CI, 1, 0.74). CONCLUSION: Peripheral nerve blocks serve as a clinical tool in mapping migraine trigger points for surgical intervention while offering more flexibility in their administration and recording as compared to established diagnostic methods.

The Relationship of Psychiatric Variables in Patients Undergoing Peripheral Nerve Surgery for Migraine Headache

BACKGROUND: Patients seeking peripheral nerve surgery for their headaches often have debilitating symptoms that can affect both their functional and psychological well-being. Although prior studies have shown strong associations between psychiatric variables and migraine headaches, their associations in patients undergoing peripheral nerve surgery have not been fully elucidated. This study aims to explore the relationship of psychiatric comorbidities in patients undergoing peripheral nerve surgery for their headaches. METHODS: One hundred twenty-nine patients were enrolled prospectively and completed the Patient Health Questionnaire-2 (PHQ-2) and Migraine Headache Index (MHI) surveys preoperatively and at 12 months postoperatively. Data on psychiatric comorbidities were collected both via survey and via retrospective chart review. RESULTS: Preoperatively, 38% of patients self-reported a diagnosis of depression, whereas 45% of patients met PHQ2 criteria for likely major depressive disorder (PHQ-2 score of 3 or greater). Twenty-seven percent of patients reported a diagnosis of generalized anxiety disorder. Patients with depressive symptoms and self-reported anxiety were more likely to report a higher severity of migraine symptoms. At 1-year postoperatively, patients reported a significant decrease in their PHQ-2 score (P = 0.02), with 22% of patients reporting depressive symptoms, as compared to 45% preoperatively. The preoperative presence of anxiety or depression did not affect postoperative outcomes. CONCLUSION: There is a high prevalence of psychiatric ailment in patients undergoing migraine surgery. Comorbid psychiatric conditions do not appear to affect postsurgical outcomes. However, surgery is associated with a significant decrease in depressive symptoms. Prior studies have shown that the surgical treatment of migraine headaches is associated with improved headache symptoms and functionality. This study demonstrates that surgery is also associated with improved psychiatric symptoms.

Peripheral Occipital Nerve Decompression Surgery in Migraine Headache.

Background:Migraine headache in the occipital region is characterized by a recurrent pain of moderate to severe intensity. However, the diagnosis can be difficult because of the multitude of symptoms overlapping with similar disorders and a pathophysiology that is not well-understood. For this reason, the medical management is often complex and ineffective.Methods:A literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted to evaluate the surgical treatment of occipital migraines. Inclusion criteria were: English language, diagnosis of migraine, occipital neuralgia, or tension headache in compliance with the classification of the International Headache Society, follow-up at minimum 3 months, and adult age. The treatment had to consist of peripheral occipital nerve surgery.Results:323 records were identified after duplicates were removed, 30 full text articles were assessed for eligibility, and 9 records were selected for inclusion. A total of 1046 patients were included in the review. General positive response after surgery (>50% reduction in occipital migraine headaches) ranged from 80.0% to 94.9%. However, many differences in the selection of patients, target of decompression surgery, and measurement outcome were described.Conclusion:Despite the decennial proven effectiveness and safeness of surgical therapy for chronic occipital migraine headaches, more significant proof is needed to definitively confirm its use as a standard therapy.

Patient Pain Sketches Can Predict Surgical Outcomes in Trigger-Site Deactivation Surgery for Headaches.

Patient selection for headache surgery is an important variable to ensure successful outcomes. In the authors' experience, a valuable method to visualize pain/trigger sites is to ask patients to draw their pain. The authors have found that there are pathognomonic pain patterns for each site, and typically do not operate on patients with atypical pain sketches, as they believe such patients are poor surgical candidates. However, a small subset of these atypical patients undergo surgery based on other strong clinical findings. In this study, the authors attempt to quantify this clinical experience. Patients were prospectively enrolled and completed pain sketches at screening. One hundred six diagrams were analyzed/categorized by two independent, blinded reviewers as follows: (1) typical (pain over nerve distribution, expected radiation); (2) intermediate (pain over nerve distribution, atypical radiation); or (3) atypical (pain outside of normal nerve distribution, atypical radiation). Preoperative and postoperative Migraine Headache Index was compared between subgroups using unpaired t tests. Migraine Headache Index improvement was 73 ± 38 percent in the typical group, 78 ± 30 percent in the intermediate group, and 30 ± 40 percent in the atypical group. There was a significant difference in Migraine Headache Index between the typical and atypical groups (p = 0.03) and between the intermediate and atypical groups (p < 0.01). The chance of achieving Migraine Headache Index improvement greater than 30 percent in the atypical group was 20 percent. Patient pain sketches classified as atypical (facial pain, atypical pain point origin, diffuse pain) can predict poor outcomes in headache surgery. As the authors continue to develop patient selection criteria for headache surgery, patient sketches should be considered as an effective, cheap, and simple-to-interpret tool for selecting candidates for surgery.

The Efficacy of Surgical Treatment for Headaches in Patients with Prior Head or Neck Trauma

Patients undergoing trigger-site deactivation surgery for headaches report a high prevalence (approximately 37 percent) of prior head or neck injury. Traditional medical treatment often fails to treat these posttraumatic patients. It is unclear whether surgery mirrors these poor outcomes. This study aims to describe the characteristics of posttraumatic headache surgery patients and compare their postoperative results to those of patients without a history of head or neck injury. One hundred forty-two patients undergoing trigger-site deactivation surgery were prospectively enrolled. Patients were requested to complete a preoperative questionnaire on headache history, including the Migraine Headache Index and information on prior head or neck injury. Follow-up surveys were requested at approximately 12 months postoperatively. Seventy patients (49 percent) reported a history of head or neck injury, and 41 (29 percent) classified the injury as the precipitating event leading to their headache onset. Patients with a precipitating event were significantly less likely to report a family history of migraine. There was no significant difference in mean preoperative Migraine Headache Index between cohorts. At 12 months postoperatively, there was no significant difference in Migraine Headache Index reduction between groups. The proportion of patients who experienced at least a 50 and 80 percent improvement in Migraine Headache Index per group, respectively, was 83 and 67 percent (atraumatic), 76 and 68 percent (posttraumatic), and 71 and 63 percent (precipitating event). This study suggests that surgical outcomes in posttraumatic headache patients are comparable to those without injury. Trigger-site deactivation surgery candidates with a history of injury can therefore expect similar outcomes as reported for patients overall. Risk, II.

Abstract 33: Psychiatric Conditions In Patients Undergoing Trigger Site Deactivation Surgery For Nerve Compression Headaches

Purpose: Patients seeking surgery for their nerve compression headaches often have debilitating symptoms that can affect both their functional and psychological well-being. Prior studies have shown strong associations between psychiatric conditions and migraine headaches. This correlation has not been investigated in patients undergoing surgery for headaches. Methods: One-hundred and twenty-nine patients were enrolled prospectively and completed the Patient Health Questionnaire-2 (PHQ-2) and Migraine Headache Index (MHI) surveys preoperatively and at twelve months postoperatively. Data on psychiatric comorbidities were collected both via survey and via retrospective chart review. Results: Preoperatively, 38% of patients self-reported a diagnosis of depression, while 45% of patients met PHQ-2 criteria for likely major depressive disorder (PHQ-2 score of three or greater). Twenty-seven percent of patients reported a diagnosis of generalized anxiety disorder. Patients with self-reported depression and anxiety were more likely to report a higher severity of migraine symptoms (P<0.01 and P=0.025, respectively). At one year postoperatively, patients reported a significant decrease in their PHQ-2 score (P=0.02), with 22% of patients reporting depressive symptoms, as compared to 45% preoperatively. The preoperative presence of anxiety or depression did not affect postoperative outcomes. Conclusion: There is a high prevalence of depression and generalized anxiety disorder in patients undergoing surgery for nerve compression headaches. Comorbid psychiatric conditions do not appear to affect postsurgical outcomes. However, surgery is associated with a significant decrease in depressive symptoms. Prior studies have shown that the surgical treatment of migraine headaches is associated with improved headache symptoms and functionality. This study demonstrates that surgery is also associated with improved mental health.

Population-Based Health Utility Assessment of Migraine Headache Symptoms before and after Surgical Intervention.

Approximately 30 million Americans suffer from migraine headaches. The primary goals of this study are to (1) use Migraine-Specific Symptoms and Disability criteria and Migraine Headache Index to describe the symptomatic improvement following decompressive surgery for refractory migraines, and (2) use the average Migraine Headache Index preoperatively and postoperatively for health utility assessment from a healthy patient's perspective. The Migraine-Specific Symptoms and Disability criteria and the Migraine Headache Index were used to characterize migraine symptoms in the authors' patient population before and after decompressive surgery. Healthy individuals were randomized to a scenario in which they assumed either the preoperative or postoperative average patient symptom profile described by the authors' migraine patients. Health utility assessments were used to quantify the evaluation of health states the authors' patients experienced before and after surgical migraine therapy. Twenty-five patients underwent surgery for migraine headaches. The Migraine-Specific Symptoms and Disability questionnaire showed a significant decrease in both frequency of headaches per month (p < 0.0001) and overall pain score (p = 0.007). The Migraine Headache Index demonstrated a statistically significant improvement (p = 0.03). Healthy individuals in the preoperative group had significantly lower utility scores compared with the postoperative group in all of the health utility assessments completed for migraine symptoms. This is the first study to use health utility assessments to attest the efficacy of decompressive therapy by demonstrating the population perspective, which perceived a significant improvement in quality of life following the surgical treatment of migraines in the authors' patients. Therapeutic, IV.