Promising Results for Migraine Surgery
Results from a new study published this month in the journal, Plastic and Reconstructive Surgery, suggest that surgical treatment for migraine may be beneficial for certain individuals with the condition. Surgical treatment for migraine has been an up-and-coming option, and its efficacy is currently being studied more and more. In this study, 90 individuals with chronic, severe migraine who did not respond to other traditional treatment options underwent the procedure and were given surveys to assess their pain and disability levels. Of the 90 individuals, 74 were included in the final study, and represent the number of individuals who took a pre-operative survey, underwent the procedure, and took a post-operative survey a year later.
Forehead lifts leading to less severe or less frequent migraine
The idea for migraine surgery was developed after a trend was noticed following cosmetic forehead lift surgeries. Specifically, plastic surgeons noticed that individuals with migraine who had a forehead lift, often reported less severe or less frequent migraines after the surgery. From this, a procedure designed to lessen the effects of migraine was developed that affects migraine pain and trigger sites that are associated with various headache patterns. All of the individuals involved in the study underwent surgical migraine treatment between 2013 and 2015, performed by Dr. William Gerald Austen Jr. Dr. Austen is a member of the American Society of Plastic Surgeons and practices at Massachusetts General Hospital.
Migraine Headache Inventory
Typically, when investigating surgical treatment options for migraine, results are collected using the Migraine Headache Inventory (MHI). The MHI is a standard migraine-related questionnaire. However, the researchers involved in this new study did something that hadn’t previously been tried before. In addition to administering the MHI survey, they also asked individuals involved in the study to take the Pain Self Efficacy Questionnaire (PSEQ). This survey is used to evaluate pain relief outcomes across many conditions, including arthritis pain, lower back pain, or nerve pain. The PSEQ is a widely used survey, and has been utilized with pain-related conditions that are well understood.
Investigating how people cope with pain
Investigating the responses from this survey were able to help the researchers get a sense of the overall pain-related changes in an individual’s life after the surgery, since the PSEQ also investigates how (or if) an individual is able to cope with pain, as well as their disability level when performing daily tasks. Overall, the survey helps paint a better picture of an individual’s daily quality of life rather than evaluating the specific characteristics of migraine that they have. Before the surgery, the individuals with migraine had extremely poor PSEQ scores, high levels of disability, and low pain coping scores. Specifically, the pain coping scores before surgery were much lower than those with other chronic pain-inducing conditions. Typically, when individuals score very low on the PSEQ, treatment outcomes are also poor. However, this was not the case for individuals who underwent surgical treatment for migraine.
Results a year after surgery
At the conclusion of the study, one year later, every individual had an increase in their PSEQ score from baseline, meaning that they were able to better cope with pain, and experienced less pain and life-changing disability. On average this change was 112% higher, an incredibly substantial positive change. For reference, after nonsurgical treatment for lower back pain, individuals generally only have an increase in their PSEQ score of 19%. Additionally, scores on the MHI were also 76% higher a year after surgery.1
Although more studies will need to be done to strengthen this data and provide more evidence on the efficacy of the surgical procedure for migraine, these results are promising and unique.
- Gfrerer L, Lans J, Faulkner HR, et al. Ability to cope with pain puts migraine surgery patients in perspective. Plastic and Reconstructive Surgery. Jan 2018; 141(1), 169-174.