Study Finds Migraine Surgery Produces ‘Dramatic Improvements’ in Functioning

According to a study published in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), surgical treatment for migraine improves everyday functioning and coping ability in addition to reducing headache frequency and severity.

“Our study demonstrates the high functional disability experienced by migraine patients, compared to those with other pain conditions,” comments ASPS Member Surgeon William Gerald Austen, Jr, of Massachusetts General Hospital. “The findings also suggest that, even in individuals who are severely impaired prior to surgery, migraine surgery can result in significant gains in functioning and coping abilities.”

Standard Pain Assessments Show Functional Improvement after Migraine Surgery

For certain patients with chronic, severe migraine headaches who do not respond to traditional therapy, surgery has emerged as an effective treatment option. Migraine surgical treatments were developed by plastic surgeons who found that some migraine patients had less headaches following a cosmetic forehead lift. They target trigger areas connected to certain headache patterns.

Most migraine surgery research, on the other hand, has relied on migraine-specific questionnaires. “Pain questionnaires used in the evaluation of better-understood and more common pain syndromes have not been applied to migraine surgery,” Dr. Austen and coauthors write.

The Pain Self Efficacy Questionnaire (PSEQ) was used in the study to assess the performance of one such questionnaire in migraine surgery patients. The PSEQ has been used to investigate therapy outcomes in a variety of pain patients.

It not only provides pain ratings but also functional disability and the ability to manage with discomfort while completing daily tasks.

It seems that migraine surgery patients can recover function and ability to cope with pain very well after surgery, in stark contrast to what has been shown in other pain conditions.

Dr. Austen and coauthors

The study comprised 90 individuals who had Dr. Austen perform migraine surgery on them between 2013 and 2015. Patients were assessed using a conventional migraine questionnaire (the Migraine Headache Inventory, or MHI) and the PSEQ before and after surgery.

At a one-year follow-up after migraine surgery, 74 patients completed both questionnaires and were included in the final analysis.

Prior to surgery, the patients’ PSEQ scores were “extremely poor,” indicating a high level of disability. Migraine patients’ preoperative pain coping scores were much lower than those reported for patients with other forms of chronic pain, such as neuropathic (nerve-related) pain, arthritis, or lower back pain.

The patients’ average PSEQ score improved by 112 percent a year following migraine surgery, compared to baseline. This was substantially higher than in studies of patients with other types of chronic pain: for example, nonsurgical treatment for low back pain resulted in an average 19 percent improvement.

Even in patients with relatively low initial PSEQ ratings, migraine surgery improved functioning and coping. In contrast, low PSEQ scores predict poor treatment outcomes in patients with musculoskeletal issues such low back pain.

“It seems that migraine surgery patients can recover function and ability to cope with pain very well after surgery, in stark contrast to what has been shown in other pain conditions,” Dr. Austen and coauthors write. They also highlight that surgery improved the migraine-specific MHI score by 76 percent on average, which measures headache frequency, duration, and severity.

In carefully selected patients, the new study found “continuing favorable results” after migraine surgery, including significant reductions in migraine-related disability.

Dr. Austen and colleagues conclude, “Chronic pain questionnaires such as the PSEQ add to our understanding of functional outcome after surgery and put pain in migraine surgery patients in perspective to better-known pain conditions.”

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