Purpose: The disability from migraine headache (MH) is an enormous health burden affecting over 30 million Americans. This study was designed to assess the long-term efficacy of surgical deactivation of MH trigger sites.
Methods: One hundred twenty-five volunteers were randomly assigned to the treatment (n=100) or control group (n=25) after examination by our neurologist to ensure a diagnosis of migraine. Patients were asked to complete previously validated questionnaires including the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Migraine Specific Quality of Life (MSQ), and Migraine Disability Assessment (MIDAS) questionnaires prior to treatment and at the postoperative follow-up. The treatment group received botulinum toxin A for identification of trigger sites, while controls received saline injections. Patients in the treatment group who experienced improvement in their migraines lasting for at least 4 weeks post-injection underwent surgical deactivation of trigger site(s). Surgical treatment included removal of the corrugator muscle group for the patients with frontal MH, avulsion of the zygomaticotemporal branch of the trigeminal nerve for the patients with temporal MH, septoplasty and turbinectomy for the patients with MH triggered from the internal nose, and removal of a small segment of the semispinalis capitis muscle and shielding of the greater occipital nerve for those with occipital MH. The results were analyzed at least 5 years postoperatively.
Results: Eighty-nine/100 patients in the treatment group underwent surgery and 79 have been followed for 5 years. Seventy-one/79 (90%) have maintained the initial positive response to the surgery. Twenty-two (28%) had elimination of migraines, 49 (62%) noticed a significant decrease, and 8 (10%) experienced no significant change. When compared to baseline data, a significant improvement in all measured variables was observed at the 5 year period (p<0.0001). A Repeated Measures ANOVA demonstrated that the improvement in migraine frequency (p<0.001), intensity (p<0.001), and duration (p<0.001) observed immediately after surgery remained stable over the 5 year follow-up period.
Conclusions: Based on the 5 year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and/or intensity of migraine headaches.