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Surgical Elimination of Migraine Headache
Guyuron B., Tucker T., Behmand R.A., Davis J.
Posted September 2002
Headache 2002; 42:403

Our research team recently reported that one of the triggers of migraine headache might be related to the compression of the trigeminal sensory nerve branches passing through the corrugator supercilii muscle in a subgroup of migraine patients. This prospective study was conducted to further evaluate the effects of surgical removal of the corrugator supercilii muscles and transection of the zygomaticotemporal branches of the trigeminal nerve on migraine headache. Prior to enrollment in the study, patients were diagnosed with migraine headache by the teamís neurologist, in accordance with the International Headache Society guidelines. Patients maintained an accurate daily diary of their headaches both prior to and after the treatments. The patients likely to have a positive outcome from surgery were identified using the injection of botulinum toxin (Botox). After two months, those with either an improvement (50% improvement in either frequency or intensity) or elimination of their headaches with Botox injections were selected to undergo surgery. Patients in whom the injection of Botox resulted in complete elimination of migraine headache underwent resection of the corrugator supercilii muscles only. Those who experienced significant improvement underwent transection of the zygomaticotemporal branch of the trigeminal nerve in addition to corrugator supercilii muscle resection. Temple soft tissues were repositioned to prevent recoaptation of the nerve endings.

Twenty-two of 24 patients, average 43 years (range 24-58) who had a favorable response to the injection of Botox underwent surgery. Of the 22 patients, 21 observed a postoperative improvement. Ten patients reported complete elimination of migraine headaches and 11 patients noted a considerable improvement (at least 50% in either frequency or intensity). For the entire surgery group, the average intensity of the migraine headache decreased from 8.9 to 4.1, on an analog scale of 1-10 (10 being most severe), while the frequency of migraine headaches was reduced from an average of 5.2 migraine per month to an average of 0.8 per month. For the group who experienced an improvement, but not elimination, the intensity fell from 9.0 to 7.5 and the frequency decreased from 5.6 to 1.0 per month. Only one patient did not notice a change. The follow up ranged from 222 to 494 days, the average being 347 days. Consequently, this study is an early indicator of the significant benefits which are associated with surgical decompression of the trigeminal sensory nerve branches in migraine headache patients. In addition, it suggests that the injection of Botox is a reliable predictor of surgical outcome.