Cleveland, Ohio From the Department of Plastic Surgery, University Hospitals Case Medical Center.
Plast Reconstr Surg. 2014 Apr;133(4):897-903. doi: 10.1097/PRS.0000000000000045.
This study was designed to report the details of the technique and assess the efficacy of surgical deactivation of temporal-triggered migraine headaches. It also examined the effect of surgical deactivation of temporal-triggered migraine headaches on migraine triggers and associated symptoms besides the pain.
The authors analyzed the charts of 246 patients receiving surgery for temporal-triggered migraine headaches by a single surgeon (B.G.) over a 10-year period, who were followed for at least 1 year. Median regression adjusted for age, sex, and follow-up time was used to determine postoperative reduction in temporal-specific migraine headache index, which is the product of frequency, severity, and duration. The association between individual symptom or trigger resolution and index value reduction was studied by logistic regression. Details of the surgical treatment are discussed.
Eighty-five percent of patients reported a successful surgery (≥50 percent improvement of headache index) at least 12 months after surgery (mean follow-up, 3 years). Fifty-five percent reported complete elimination of temporal migraine headache. Symptoms resolving with successful site II surgery included nausea, photophobia, phonophobia, difficulty concentrating, vomiting, blurry vision, and eyelid ptosis (p < 0.05). Triggers resolving included letdown after stress, air travel, missed meals, bright lights, loud noises, fatigue, weather change, and certain smells (p < 0.05).
Surgical deactivation of temporal-triggered migraine headaches is effective regardless of age, sex, or follow-up time. Successful site II surgery is associated with changes in specific symptoms and triggers. This information can assist in trigger avoidance and contribute to constellations used for temporal-triggered migraine headaches trigger-site identification.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究旨在报告手术治疗时间触发型偏头痛的技术细节，并评估其疗效。我们还检查了手术治疗时间触发型偏头痛除疼痛外对偏头痛触发因素和相关症状的影响。
作者分析了一位外科医生（B.G.）在 10 年内对 246 例时间触发型偏头痛患者进行手术的病历，这些患者至少随访了 1 年。采用中位数回归调整年龄、性别和随访时间，以确定术后颞叶特异性偏头痛头痛指数的减少，该指数是频率、严重程度和持续时间的乘积。通过逻辑回归研究单个症状或触发因素的缓解与指数值减少之间的关系。讨论了手术治疗的细节。
85%的患者在手术后至少 12 个月（平均随访 3 年）报告手术成功（头痛指数改善≥50%）。55%的患者报告颞叶偏头痛完全消除。成功的 II 型手术缓解的症状包括恶心、畏光、恐声、注意力不集中、呕吐、视力模糊和眼睑下垂（p < 0.05）。缓解的触发因素包括压力后低落、航空旅行、错过进餐、亮光、大声、疲劳、天气变化和某些气味（p < 0.05）。
手术治疗时间触发型偏头痛的效果不受年龄、性别或随访时间的影响。成功的 II 型手术与特定症状和触发因素的变化有关。这些信息可以帮助避免触发因素，并有助于确定时间触发型偏头痛触发部位的组合。
临床问题/证据水平：治疗性，IV。
