From the Department of Plastic Surgery, University Hospitals; and Case Western Reserve University School of Medicine.
Plast Reconstr Surg. 2019 Feb;143(2):557-563. doi: 10.1097/PRS.0000000000005261.
This study reports the surgical technique and efficacy of treatment for the less commonly studied auriculotemporal nerve (site V). The aim was to evaluate symptom relief and differences in migraine headache parameters (i.e., intensity, duration, and migraine-free days) after site V surgery.
Patients undergoing site V surgery for auriculotemporal nerve-triggered migraine headaches were analyzed. Charts were reviewed retrospectively for age, sex, dates of surgery and follow-up, preoperative migraine data, types of surgery, and laterality. Postoperatively, patients completed a migraine headache questionnaire by means of office visit, phone, e-mail, or video conference.
Forty-three patients were included in the study (36 women; median age, 50 years; interquartile range, 40 to 57 years). The majority of patients underwent bilateral surgery (n = 36) and reported site-specific relief (n = 34). The average follow-up was 17.2 months. The number of migraine-free days (per month) increased from 12.6 days before surgery to 25.1 days after surgery (median increase, 12.6 days; p < 0.005). Median migraine intensity scores decreased from 8.3 to 3.2 after surgery (median decrease, 5.1; p < 0.005) on 10-point severity scale. Migraine duration decreased from 1.2 hours/day to 0.5 hour/day after surgery (median decrease, 0.7 hour/day, p < 0.005). The median difference in migraine duration was the only value found not to be statistically significant, defined as p < 0.005. On both univariate and multivariate analyses, patient-reported site relief was significantly associated with decreased migraine intensity.
Surgery for auriculotemporal nerve-triggered migraine headaches improves migraine headache parameters. This study is the first to examine surgical efficacy of this less commonly studied trigger site.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究报告了一种针对较少研究的耳颞神经（V 区）的手术技术和治疗效果。目的是评估 V 区手术后缓解症状和偏头痛头痛参数（即强度、持续时间和无偏头痛天数）的差异。
分析了因耳颞神经触发偏头痛而接受 V 区手术的患者。通过门诊、电话、电子邮件或视频会议，回顾性地对图表进行了年龄、性别、手术和随访日期、术前偏头痛数据、手术类型和侧别进行了分析。手术后，患者通过偏头痛头痛问卷完成。
本研究纳入了 43 例患者（36 名女性；中位年龄 50 岁；四分位间距 40 至 57 岁）。大多数患者接受了双侧手术（n=36），并报告了特定部位的缓解（n=34）。平均随访时间为 17.2 个月。无偏头痛天数（每月）从术前的 12.6 天增加到术后的 25.1 天（中位数增加 12.6 天；p＜0.005）。中位数偏头痛强度评分从术后的 8.3 分降至 3.2 分（中位数下降 5.1 分；p＜0.005），使用 10 分严重程度量表。偏头痛持续时间从 1.2 小时/天降至术后 0.5 小时/天（中位数下降 0.7 小时/天，p＜0.005）。偏头痛持续时间的中位数差异是唯一未发现具有统计学意义的值，定义为 p＜0.005。在单变量和多变量分析中，患者报告的部位缓解与偏头痛强度降低显著相关。
针对耳颞神经触发的偏头痛头痛的手术可改善偏头痛头痛参数。本研究首次检查了这一较少研究的触发部位的手术效果。
临床问题/证据水平：治疗性，IV 级。
