Lineberry Kyle, Lee Michelle, Monson Andrea, Guyuron Bahman
Cleveland, Ohio From the Department of Plastic Surgery, University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; and the Department of Plastic Surgery, Case Western Reserve University.
Plast Reconstr Surg. 2015 Feb;135(2):393e-396e. doi: 10.1097/PRS.0000000000000862.
A subset of patients have been noted to have refractory migraine symptoms in site IV (occipital triggers) following primary surgery. It was postulated that the cause of refractory migraine symptoms is new scar tissue formation causing irritation of the greater occipital nerve. The goal of this study was to determine whether intraoperative corticosteroid injections have the potential to prevent these refractory symptoms.
A retrospective review of all patients operated on by the senior author (B.G.) from 2000 to 2010 was undertaken. All patients who had site IV decompression and at least 1 year of follow-up were included. Patients were divided into two groups, those who had corticosteroids injected and those who did not. Data analyzed included demographics and preoperative and postoperative migraine headache symptoms review based on the migraine headache questionnaire.
A total of 476 patients were included in the study. There were 282 patients in the corticosteroid group and 194 in the no-corticosteroid group. A significant reduction was found in the frequency of migraine headaches (-9.8 versus -8.0; p = 0.03) and the migraine headache index (-92.9 versus -65.2; p = 0.0065). There was no significant reduction in migraine headache duration (-0.50 versus -0.70; p = 0.10) or severity (-3.50 versus -3.80; p = 0.38).
Intraoperative injection of corticosteroids during site IV migraine surgery may reduce migraine frequency and migraine headache index postoperatively. Corticosteroid injection in migraine site IV surgery is an effective adjunctive measure in reducing the migraine headache index.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
已注意到一部分患者在初次手术后，在IV区（枕部触发点）出现难治性偏头痛症状。据推测，难治性偏头痛症状的原因是新瘢痕组织形成，导致枕大神经受到刺激。本研究的目的是确定术中注射皮质类固醇是否有可能预防这些难治性症状。
对资深作者（B.G.）在2000年至2010年期间手术的所有患者进行回顾性研究。纳入所有接受IV区减压且至少随访1年的患者。患者分为两组，一组接受皮质类固醇注射，另一组未接受。分析的数据包括人口统计学资料以及基于偏头痛问卷的术前和术后偏头痛症状回顾。
本研究共纳入476例患者。皮质类固醇组有282例患者，非皮质类固醇组有194例患者。发现偏头痛发作频率（-9.8对-8.0；p = 0.03）和偏头痛指数（-92.9对-65.2；p = 0.0065）有显著降低。偏头痛持续时间（-0.50对-0.70；p = 0.10）或严重程度（-3.50对-3.80；p = 0.38）没有显著降低。
IV区偏头痛手术中术中注射皮质类固醇可能会降低术后偏头痛发作频率和偏头痛指数。IV区偏头痛手术中注射皮质类固醇是降低偏头痛指数的有效辅助措施。
临床问题/证据级别：治疗性，III级。
