Factors contributing to migraine headache surgery failure and success.

BACKGROUND

The purpose of this study was to identify factors that contribute to migraine headache surgery failure and success.

METHODS

A retrospective chart review was conducted of patients who underwent surgery for migraine headaches performed by the senior author (B.G.) and had at least 11 months of follow-up. The study population included three groups: migraine surgery success, improvement, and failure. Thirty-six unique data points were collected for each patient.

RESULTS

A total of 169 patients met inclusion criteria. Of these, 66 patients comprised the migraine surgery success group (S, complete elimination of migraine headaches); 67 comprised the migraine surgery improvement group (I, >50 percent reduction in migraine frequency, intensity, or duration); and 36 comprised the migraine surgery failure group (F, <50 percent reduction in migraine frequency, intensity, or duration). Significant differences among the groups included age at surgery (S>I, p=0.02), migraine frequency (S<I, p=0.02), age of migraine onset (S>I, p=0.003; S>F, p=0.04), history of head or neck injury (S<I, p=0.04), daily use of over-the-counter migraine medications (S<I, p=0.05), visual symptoms (S>I, p=0.02), increased intraoperative bleeding (S<F, p=0.04; I<F, p=0.04), site I (S>F, p=0.0006; I>F, p=0.0004), site II (S>F, p=0.015), single operative site (S<F, p=0.005), one to two operative sites (S<F, p=0.04; I<F, p=0.01), and four operative sites (S>I, p=0.05; S>F, p=0.04).

CONCLUSIONS

Factors associated with migraine surgery failure include increased intraoperative bleeding and surgery on fewer trigger sites. Factors associated with migraine surgery success are older age of migraine onset, higher rate of visual symptoms versus improvement group, surgery at site I or II, and deactivating all four operative sites.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.