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      Surgical Treatment of Frontal and Occipital Migraines: A Comparison of Results

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          Abstract

          BACKGROUND The World Health Organization ranked migraine as the 19th worldwide disease causing disability. 1,2 Surgical resection of forehead and/or occipital muscles has been related to the relief of migraine; indeed, inflammation and hyperexcitability of peripheral craniofacial nerves due to local compression might constitute a trigger for this pathology. 3–5 METHODS We performed a retrospective comparison between 2 surgical procedures: our modified technique of selective endoscopic myotomies of corrugator supercilii, depressor supercilii, and procerus muscles 6–8 for frontal migraine (group A) versus the surgical isolation of the greater and the lesser occipital nerves for disease originating on the posterior region (group B). Both procedures were performed under local anesthesia as 1-day surgery. Group A was constituted by 43 patients who, after a 1.5-cm long midline scalp incision (Fig. 1) and subgaleal dissection, underwent selective myotomies and decompression of the supraorbital and supratrochlear nerves. In group B, 22 patients, after an 8-cm-long scalp incision along the superior nuchal midline (Fig. 2) and dissection of local muscles, underwent release of the greater and the lesser occipital nerves by ligation of the (usually dilated) occipital vascular bundles. For both groups, follow-up ranged from 6 to 24 months. Fig. 1. Endoscopic procedure for the treatment of frontal migraine. Fig. 2. In surgical treatment of occipital migraine, after subcutaneous and muscular dissection, the greater occipital nerves running below the occipital artery are shown (scissors). RESULTS In group A, 93.3% of the patients reported a positive response to the surgery (33.3% complete elimination of disease and 60% significant improvement), whereas 6.6% did not notice any change in symptoms. In group B, 92.3% of the patients obtained a positive response (84.6% complete relief from symptoms and 7.7% a significant reduction), whereas in 7.7% of the patients no improvement was noticed. CONCLUSIONS In summary, the surgical procedure performed in group B led to significantly better results (84.6% versus 33.3%) when taking into account complete healing rates. These results might be due to the fact that frontal migraine is caused by muscular local compression of the nerves, which sometimes relapse because neo-formed scar tissue might compress the nerves again, whereas in occipital migraine (provoked mainly by the compression determined by dilated arterial vessels: occipital artery) after occipital artery resection combined with myotomies, the trigger points were no longer overstimulated.

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          Epidemiology of headache in Europe.

          The present review of epidemiologic studies on migraine and headache in Europe is part of a larger initiative by the European Brain Council to estimate the costs incurred because of brain disorders. Summarizing the data on 1-year prevalence, the proportion of adults in Europe reporting headache was 51%, migraine 14%, and 'chronic headache' (i.e. > or =15 days/month or 'daily') 4%. Generally, migraine, and to a lesser degree headache, are most prevalent during the most productive years of adulthood, from age 20 to 50 years. Several European studies document the negative influence of headache disorders on the quality of life, and health-economic studies indicate that 15% of adults were absent from work during the last year because of headache. Very few studies have been performed in Eastern Europe, and there are also surprisingly little data on tension-type headache from any country. Although the methodology and the quality of the published studies vary considerably, making direct comparisons between different countries difficult, the present review clearly demonstrates that headache disorders are extremely prevalent and have a vast impact on public health. The data collected should be used as arguments to increase resources to headache research and care for headache patients all over the continent.
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            Corrugator supercilii muscle resection and migraine headaches.

            This study was conducted to determine whether there is an association between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches. Questionnaires were sent to 314 consecutive patients who had undergone corrugator supercilii muscle resection during endoscopic, transpalpebral, or open forehead rejuvenation procedures. The patients were queried as to whether they had a history of migraine headaches and, if so, whether the headaches significantly improved or disappeared after surgery. If the answer was affirmative, then the patients were further questioned about the duration of the improvement or cessation of the headaches and the relationship to the timing of the surgery. After an initial evaluation of the completed questionnaires, a telephone interview was conducted to confirm the initial answers and to obtain further information necessary to ensure that the patients had a proper diagnosis based on the International Headache Society criteria for migraine headaches. The charts of the patients who had migraine headaches were studied to ascertain and classify the type of surgery they had undergone. Patient demographics were reviewed, and the results were statistically analyzed. Of the 314 patients, 265 (84.4 percent) either responded to the questionnaire, were interviewed, or both responded to the questionnaire and were interviewed. Of this group, 16 patients were excluded because of the provision of insufficient information to meet the International Headache Society criteria, the presence of organic problems, and other exclusions mandated by study design. Thirty-nine (15.7 percent) of the remaining 249 patients had migraine headaches that fulfilled the Society criteria. Thirty-one of the 39 (79.5 percent) with preoperative migraine noted elimination or improvement in migraine headaches immediately after surgery (p < 0.0001; McNemar), and the benefits lasted over a mean follow-up period of 47 months. When the respondents with a positive history of migraine headaches were further divided, 16 patients (p < 0.0001; McNemar) noticed improvement over a mean follow-up period of 47 months, and 15 (p < 0.0001; McNemar) experienced total elimination of their migraine headaches over a mean follow-up period of 46.5 months. When divided by migraine headache type, 29 patients (74 percent) had nonaura migraine headaches. Of these patients, the headaches disappeared in 11 patients, improved in 13 patients, and did not change in five patients (p < 0.0001). Ten patients experienced aura-type headaches, which disappeared or improved in seven of the patients and did not change in three of the patients (p < 0.0001). This study proves for the first time that there is indeed a strong correlation between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches.
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              Endoscopic forehead surgery for migraine therapy Personal technique.

              The aim of this study is to prove the therapeutic effectiveness of nerve decompression, performed endoscopically for frontal migraine and by open surgery for occipital migraine.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Wolters Kluwer Health
                2169-7574
                March 2016
                18 March 2016
                : 4
                : 3
                Affiliations
                From the [* ]Plastic Surgery Division, Department of Surgical Sciences, University of Parma, Parma, Italy; and []The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy.
                Author notes
                Susanna Polotto, MD, The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy, E-mail: polotto.susanna@ 123456gmail.com
                Article
                00033
                10.1097/GOX.0000000000000631
                4874297
                27257583
                Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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