Surgical Treatment of Migraine Headaches: A Review of Surgical Technique, Clinical, Anatomical and Radiological Studies

Abstract

Migraine is a neurovascular disorder, the incidence of which has been reported to be 2.38% in one study conducted in Turkey in 2015. The diagnosis and the medical treatment of migraine is the field of neurology specialists. Until today, the primary treatment of migraine progressed as a medical therapy, in which beta-blockers, calcium channel blockers, anticonvulsants, tricyclic antidepressants and neurotoxins were used. Manymigraine patients undergo medical therapies for recovery and also try to control triggering environmental factors. In some patients who experience migraine attacks, the cause has been seen to lie more peripherally and to be associated with the irritation and the compression of the trigeminal nerve branches, namely of the sensory nerves of the face and the scalp. This has led to the involvement of plastic surgeons in this area for surgically decompressing such nerves, and many successful clinical results have been reported by various plastic surgery centers. This surgical treatment, which falls under the scope of plastic surgery, has been demonstrated to be successful in select suitable cases. In this study, we aimed at providing a review of the literature on the surgical techniques, anatomical, clinical, radiological studies of migraine surgery whilst revisiting the currently available information. Accurate identification of the trigger points is a fundamental component of a successful migraine surgery. Failure to do so can, inevitably, fall short of the treatment goals and lead to weak response. Given the central and peripheric pathophysiology of migraine, these six peripheral points constitute the target of the plastic surgeon. In a number of publications, surgical procedures performed on these trigger points have been demonstrated to lead to positive outcomes. There are three case reports, eight retrospective cohort studies, three prospective cohort studies and two randomized-controlled studies that report positive outcomes in migraine surgeries. Recent developments in migraine surgery, as well as surgeries performed on the defined peripheral points have proven migraine surgery to be a safe and effective approach in suitable cases. Such developments help understand the importance of a multidisciplinary approach and also positively motivate both the surgeons and the patients towards a solution to this problem. Notwithstanding these favorable developments, surgical techniques need to be improved and modified, trigger points need to be further scrutinized, perhaps new trigger points need to be described, and patient satisfaction need to be enhanced. An analysis of the studies reported in the literature shows that further comprehensive studies will help us understand the efficacy of different treatment options. Surgical treatment of migraine will surely advance with wide-ranging and multi-centered studies on the subject.

Keywords

• Migraine
• headache
• surgical treatment