From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital.
Plast Reconstr Surg. 2020 Aug;146(2):381-388. doi: 10.1097/PRS.0000000000007019.
Patients undergoing trigger-site deactivation surgery for headaches report a high prevalence (approximately 37 percent) of prior head or neck injury. Traditional medical treatment often fails to treat these posttraumatic patients. It is unclear whether surgery mirrors these poor outcomes. This study aims to describe the characteristics of posttraumatic headache surgery patients and compare their postoperative results to those of patients without a history of head or neck injury.
One hundred forty-two patients undergoing trigger-site deactivation surgery were prospectively enrolled. Patients were requested to complete a preoperative questionnaire on headache history, including the Migraine Headache Index and information on prior head or neck injury. Follow-up surveys were requested at approximately 12 months postoperatively.
Seventy patients (49 percent) reported a history of head or neck injury, and 41 (29 percent) classified the injury as the precipitating event leading to their headache onset. Patients with a precipitating event were significantly less likely to report a family history of migraine. There was no significant difference in mean preoperative Migraine Headache Index between cohorts. At 12 months postoperatively, there was no significant difference in Migraine Headache Index reduction between groups. The proportion of patients who experienced at least a 50 and 80 percent improvement in Migraine Headache Index per group, respectively, was 83 and 67 percent (atraumatic), 76 and 68 percent (posttraumatic), and 71 and 63 percent (precipitating event).
This study suggests that surgical outcomes in posttraumatic headache patients are comparable to those without injury. Trigger-site deactivation surgery candidates with a history of injury can therefore expect similar outcomes as reported for patients overall.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
接受触发点去活手术治疗头痛的患者报告称，既往头部或颈部损伤的发生率较高（约 37%）。传统的医学治疗通常无法治疗这些创伤后患者。目前尚不清楚手术是否反映了这些较差的结果。本研究旨在描述创伤后头痛手术患者的特征，并将其术后结果与无头部或颈部损伤史的患者进行比较。
前瞻性纳入 142 例接受触发点去活手术的患者。患者被要求填写一份关于头痛病史的术前问卷，包括偏头痛头痛指数和既往头部或颈部损伤信息。术后约 12 个月进行随访调查。
70 例患者（49%）报告有头部或颈部损伤史，其中 41 例（29%）将损伤归类为导致头痛发作的诱发事件。有诱发事件的患者报告偏头痛家族史的可能性明显较低。两组患者的术前偏头痛头痛指数平均值无显著差异。术后 12 个月，两组之间的偏头痛头痛指数降低程度无显著差异。分别有 83%和 67%（无创伤组）、76%和 68%（创伤后组）、71%和 63%（诱发事件组）的患者报告偏头痛头痛指数至少改善了 50%和 80%。
本研究表明，创伤后头痛患者的手术结果与无损伤患者相当。因此，有损伤史的触发点去活手术候选者可以预期与总体患者报告的结果相似。
临床问题/证据水平：风险，II。
