Migraine surgery reduces headache days, study finds

For patients with chronic migraine, nerve decompression surgery effectively reduces the number of headache days—a preferred measure among neurologists—as well as other measures, including the frequency and intensity of migraine attacks, according to a study published in the June issue of Plastic and Reconstructive Surgery. The article is entitled "Comparison of the migraine headache index and the number of migraine days per month after nerve deactivation for headache treatment: a systematic review and meta-analysis."

"Neurologists evaluating migraine treatments tend to focus on reducing the number of headache days, while plastic surgeons performing headache surgery are more likely to use a measure that includes other headache indicators, such as the Migraine Headache Index " said ASPS member and professor of plastic surgery, surgery, neurosurgery and neurology Jeffrey E. Janis, MD, of The Ohio State University Wexner Medical Center, Columbus.

"Our study adds new evidence that headache surgery improves both sets of measures, providing a more comprehensive assessment of the outcome of headache surgery."

What results does headache surgery improve?

Peripheral nerve decompression surgery—sometimes called trigger point deactivation or headache surgery—has become an established surgical treatment for chronic migraine and some other neurological causes of headache, such as occipital and supraorbital neuralgia. Migraine surgery is aimed at relieving nerve compression in trigger areas of the head and neck that are thought to contribute to headaches.

When plastic surgeons evaluate the results of headache surgery, they typically use the Migraine Headache Index (MHI), which includes the frequency, intensity, and duration of migraine attacks. In contrast, neurologists—"the traditional experts in nonsurgical migraine treatment"—focus on changes in the number of migraine days per month.

"This discrepancy is one reason why some headache specialists have been slow to accept the growing evidence for the effectiveness of headache surgery," says Dr. Janis. Current guidelines do not recommend assessing headache intensity or duration, citing a lack of standardization.

Strong evidence for the effectiveness of headache surgery

To help bridge the gap between specialties, researchers reviewed 19 headache surgery studies that provided information on the number of migraine days per month. The studies, conducted from 2005 to 2020, included a total of 1,603 patients. Five of these studies were randomized controlled trials, which is the highest level of evidence in research.

Of eight studies assessing the number of migraine days per month before and after migraine surgery, six showed a significant reduction in the number of migraine days. In a weighted analysis, patients had an average of 14.11 fewer migraine days per month, from before to after surgery. Based on 12 studies, the total number of migraine attacks decreased by 8.65 days per month.

Other measures also improved after headache surgery, including a mean reduction in total MHI score of 76.59 points (out of a maximum of 300 points). This included an improvement in migraine intensity, which decreased by an average of 3.84 points (on a scale of 0 to 10); and duration of attacks, which decreased by 11.80 hours per month. Studies have reported no serious complications from headache surgery.

The study "demonstrates the effectiveness of headache surgery on measures used in both the plastic surgery and neurological literature," Dr. Janis and his co-authors concluded. They acknowledge some limitations of their study—especially including the variability of trigger zones addressed by headache surgery. However, the results "provide strong evidence for the effectiveness of headache surgery."

"We hope that our study will help facilitate communication between plastic surgeons and neurologists in assessing the effects of headache surgery for patients with chronic headaches," comments Dr. Janis. "Future studies of headache surgery should routinely include data on the number of migraine days per month to better compare the results of surgical and medical treatments."