Albano Nicholas J, Israel Jacqueline S, Carbullido Mary K, Stilp Emmaline K, Leverson Glen, Voils Corrine I, Afifi Ahmed M
From the Department of Surgery, Division of Plastic Surgery.
Department of Surgery, University of Wisconsin Hospital and Clinics.
Plast Reconstr Surg. 2023 Mar 1;151(3):469e-476e. doi: 10.1097/PRS.0000000000009930. Epub 2022 Nov 29.
Studies of migraine surgery have relied on quantitative, patient-reported measures like the Migraine Headache Index (MHI) and validated surveys to study the outcomes and impact of headache surgery. It is unclear whether a single metric or a combination of outcomes assessments is best suited to do so.
All patients who underwent headache surgery had an MHI calculated and completed the Headache Impact Test, the Migraine Disability Assessment Test, the Migraine-Specific Quality-of-Life Questionnaire, and an institutional ad hoc survey preoperatively and postoperatively.
Twenty-seven patients (79%) experienced greater than or equal to 50% MHI reduction. MHI decreased significantly from a median of 210 preoperatively to 12.5 postoperatively (85%; P < 0.0001). Headache Impact Test scores improved from 67 to 61 (14%; P < 0.0001). Migraine Disability Assessment Test scores improved from 57 to 20 (67%; P = 0.0022). The Migraine-Specific Quality-of-Life Questionnaire demonstrated improvement in quality-of-life scores within all three of its domains ( P < 0.0001). The authors' ad hoc survey demonstrated that participants "strongly agreed" that (1) surgery helped their symptoms, (2) they would choose surgery again, and (3) they would recommend headache surgery to others.
Regardless of how one measures it, headache surgery is effective. The authors demonstrate that surgery significantly improves patients' quality of life and decreases the effect of headaches on patients' functioning, but headaches can still be present to a substantial degree. The extent of improvement in migraine burden and quality of life in these patients may exceed the amount of improvement demonstrated by current measures.
偏头痛手术的研究依赖于定量的、患者报告的指标，如偏头痛头痛指数（MHI）以及经过验证的调查问卷，以研究头痛手术的结果和影响。目前尚不清楚单一指标还是多种结果评估指标的组合最适合用于此目的。
所有接受头痛手术的患者术前和术后均计算MHI，并完成头痛影响测试、偏头痛残疾评估测试、偏头痛特异性生活质量问卷以及一项机构特设调查。
27名患者（79%）的MHI降低幅度大于或等于50%。MHI从术前的中位数210显著降至术后的12.5（降幅85%；P < 0.0001）。头痛影响测试得分从67分提高到61分（提高14%；P < 0.0001）。偏头痛残疾评估测试得分从从57分提高到20分（提高67%；P = 0.0022）。偏头痛特异性生活质量问卷显示其所有三个领域的生活质量得分均有所改善（P < 0.0001）。作者的特设调查表明，参与者“强烈同意”：（1）手术缓解了他们症状，（2）他们会再次选择手术，（3）他们会向他人推荐头痛手术。
无论采用何种测量方法，头痛手术都是有效的。作者表明，手术显著改善了患者的生活质量，减轻了头痛对患者功能的影响，但头痛仍可能在很大程度上存在。这些患者偏头痛负担和生活质量的改善程度可能超过目前测量方法所显示的改善程度。
