Migraine headaches are a serious medical condition that can drastically reduce a patient's ability to work, participate in daily activities and function at full capacity. Medications are only a temporary fix, and many patients do not find relief. Therapies like yoga, exercise, heat or ice, and alternative medicine are also used by many who suffer the debilitating effects of these headaches.
In the United States, it's estimated that approximately 38 million adults have migraines. In 2-3 million of those patients, the headaches are chronic, occurring more than 15 days per month. Wome experience migraines at three times the rate of men.
While surgery seems like a last resort, new research of the American Society of Plastic Surgeons shows that migraine surgery not only reduces the frequency of headaches, it also reduces the severity. The study results also showed improvement in everyday functioning and coping in patients.
William Gerald Austen, Jr. an ASPS Member Surgeon and the author of the work stated, "Our study demonstrates the high functional disability experienced by migraine patients, compared to those with other pain conditions. The results also show that migraine surgery can lead to dramatic improvements in functioning and coping ability, even in patients who are very disabled before surgery."
So what is migraine surgery? It's a common question; many patients don't realize that surgical options even exist. The two most common procedures are nerve decompression and nerve ligation. In decompression surgery, trigger points in the head and neck are identified, and muscles and tissue that are compressing nerves are removed. This surgical method was a bit of serendipity for patients, having been discovered when patients who underwent "brow lift" plastic surgery found their migraines were reduced or even eliminated. Lifting tissue away from sensitive nerves that are known to trigger headaches provides relief to patients who have not seen relief from any other methods. Nerve ligation is where nerves are cut away. While it does result in small areas of the head that remain numb, most patients are not bothered by this after effect.
The recent study differed from most studies because questionnaires used in the survey asked about migraine-specific pain, but did not include surgical patients and did not address coping and function. Dr. Austen's study used the Pain Self Efficacy Questionnaire (PSEQ) which has been used in studies for an extensive range of pain syndromes, not just migraine pain.
The study worked with 90 patients who had migraine surgery, performed by Dr. Austen, between 2013 and 2015. Participants were evaluated before and after surgery using the Migraine Headache Inventory (MHI) and the PSEQ. At the end of the study, the analysis report included 74 of the original 90 patients.
As would be expected, before the surgery most of the patients had terrible PSEQ scores. Their pain levels were disabling in most cases, and coping scores were low as well, even lower than patients with other conditions that involve chronic pain, like back pain or arthritis. One year after undergoing surgery, on average the PSEQ score was 112 percent higher than it was before surgery. In other types of pain, most PSEQ scores do not improve that much. Even in patients who had the highest levels of pain pre-surgery (and the lowest PSEQ scores), there was a significant improvement. Function and coping abilities also improved.
Dr. Austen wrote in the study, "It seems that migraine surgery patients can recover function and ability to cope with pain very well after surgery, in stark contrast to what has been shown in other pain conditions." On the MHI there was an average 76% improvement for patients after surgery. The results of the study show that the PSEQ is a much better scale on which to judge pain and that surgical intervention in migraines, while the last resort, can provide an extraordinary amount of relief. The video below has additional information about migraines and why they are so debilitating.