Dallas, Texas; and St. Louis, Mo. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, and Washington University in St. Louis.
Plast Reconstr Surg. 2011 Jul;128(1):123-131. doi: 10.1097/PRS.0b013e3182173d64.
Migraine headache is a widespread neurovascular disorder that is often suboptimally or incompletely treated. This article confirms the efficacy of botulinum toxin treatment with surgical decompression as a deactivator of migraine headache trigger sites through the retrospective analysis of a single surgeon's experience.
A retrospective chart review was performed on 24 patients presenting with the diagnosis of migraine headache. Botulinum toxin type A injections were used to identify frontal, temporal, and/or occipital trigger points. The nasal trigger point was diagnosed with a decongestant trial, intranasal examination, and computed tomographic scan. Those patients with more than one trigger point underwent multiple surgical procedures, which were performed concomitantly during the same operation. All botulinum toxin injections, surgical procedures, and patient meetings were conducted by the principal investigator (J.E.J.), minimizing intrapatient treatment variability and multiprovider bias.
Patient progress was tracked by consolidating migraine frequency, severity, and duration as a Migraine Headache Index. Nineteen patients (79.2 percent) benefited from surgery. Two patients (8.3 percent) reported migraine elimination and 17 patients (70.8 percent) reported significant improvement of their migraine symptoms. Among those patients who responded to surgery, average improvement from baseline levels was 96.9 percent. Among the entire patient population, average improvement was 78.2 percent from baseline. The mean postsurgical follow-up was 661 days.
This study found botulinum toxin treatment with surgical decompression to be a potent deactivator of migraine headache trigger sites, corroborating the findings of the current literature in the field and underlining the reproducibility of the treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, IV.(Figure is included in full-text article.).
偏头痛是一种广泛存在的神经血管疾病，通常治疗效果不佳或不彻底。本文通过对一位外科医生经验的回顾性分析，证实了肉毒毒素治疗与手术减压相结合作为偏头痛触发点失活剂的疗效。
对 24 例偏头痛患者进行回顾性图表分析。A型肉毒毒素注射用于识别额部、颞部和/或枕部触发点。鼻触发点通过减充血试验、鼻内检查和计算机断层扫描进行诊断。对于有多个触发点的患者，进行了多次手术，这些手术同时在一次手术中进行。所有肉毒毒素注射、手术程序和患者会议均由主要研究者（J.E.J.）进行，最大限度地减少了患者间治疗的变异性和多提供者偏见。
通过将偏头痛频率、严重程度和持续时间综合为偏头痛头痛指数来跟踪患者的进展。19 例患者（79.2%）受益于手术。2 例患者（8.3%）报告偏头痛消除，17 例患者（70.8%）报告偏头痛症状显著改善。在对手术有反应的患者中，平均改善幅度为 96.9%。在整个患者群体中，平均改善幅度为 78.2%。平均术后随访时间为 661 天。
本研究发现，肉毒毒素治疗联合手术减压是偏头痛触发点的有效失活剂，这与该领域当前文献的研究结果相符，并强调了该治疗方法的可重复性。
临床问题/证据水平：治疗，IV。（全文包含图表。）
