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. 2016 Apr;137(4):712e-716e.
doi: 10.1097/PRS.0000000000002011.

Emergence of Secondary Trigger Sites after Primary Migraine Surgery

Ayesha Punjabi  1   2 , Matthew Brown  1   2 , Bahman Guyuron  1   2
Affiliations

Emergence of Secondary Trigger Sites after Primary Migraine Surgery

Ayesha Punjabi et al. Plast Reconstr Surg. 2016 Apr.

Abstract

Background: Surgical decompression of a migraine headache may unmask headaches originating from secondary sites. A retrospective chart review investigated the incidence and characteristics of secondary trigger sites to identify clinical patterns that could aid in predicting and perhaps reducing postoperative migraines.

Methods: One hundred eighty-five charts for migraine patients who underwent surgery at the senior author's (B.G.) practice were reviewed. Sites from which migraine headaches initiated or occurred independently were considered primary. The sites that were not active at the time of preoperative evaluation but became active after surgery were considered secondary. Bivariate analysis was performed to characterize postoperative migraines.

Results: Of 185 patients, 33 (17.8 percent) developed secondary migraine headache trigger sites. Of patients with primary site I (frontal) symptoms, 20.83 percent had site III (septonasal) symptoms unmasked after surgery (versus 7 percent for patients with other primary sites; p = 0.04). Of the patients with site II (temporal) migraines, 17.14 percent had secondary frontal symptoms (versus 5.68 percent; p = 0.04). Primary site II symptoms predicted postoperative site IV (occipital) symptoms (11.43 versus 1.1 percent; p = 0.008), and primary occipital symptoms predicted postoperative temporal symptoms (11.1 versus 2.33 percent; p = 0.04).

Conclusions: The authors observed that 17.8 percent of patients develop postoperative migraine headache triggers that are not reported during the initial assessment. Knowledge of secondary migraine emergence patterns, and the presence of some preoperative symptoms, can aid in predicting the migraines that will arise from a new site postoperatively.

Clinical question/level of evidence: Therapeutic, IV.

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References

    1. Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: A review of statistics from national surveillance studies. Headache. 2013;53:427–436.
    1. Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. Burden of migraine in the United States: Disability and economic costs. Arch Intern Med. 1999;159:813–818.
    1. Dodick DW. Triptan nonresponder studies: Implications for clinical practice. Headache. 2005;45:156–162.
    1. Gfrerer L, Maman DY, Tessler O, Austen WG Jr. Nonendoscopic deactivation of nerve triggers in migraine headache patients: Surgical technique and outcomes. Plast Reconstr Surg. 2014;134:771–778.
    1. Guyuron B, Tucker T, Davis J. Surgical treatment of migraine headaches. Plast Reconstr Surg. 2002;109:2183–2189.