Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jan 16:20:1-18.
doi: 10.1016/j.jpra.2019.01.002. eCollection 2019 Jun.

Surgical intervention for chronic migraine headache: A systematic review

J C R Wormald  1   2 , J Luck  3   4 , B Athwal  5 , T Muelhberger  6 , A Mosahebi  3   4
Affiliations
Review

Surgical intervention for chronic migraine headache: A systematic review

J C R Wormald et al. JPRAS Open. .

Abstract

Aims: Migraine is a global phenomenon, affecting more than 10% of the world's population. It is characterized by unilateral headache that may be accompanied by vomiting, nausea, photophobia and phonophobia. Some patients with chronic migraine respond to extra-cranial botulinum toxin type A injection, although the benefits observed are temporary. The rationale for surgical trigger site deactivation is to achieve lasting symptomatic improvement or permanent relief from migraine.

Methods: We performed a PRISMA-compliant systematic review of clinical studies evaluating surgical intervention for migraine by searching Ovid MEDLINE and EMBASE databases from inception to June 2017. Studies were independently screened by two authors. Data were extracted on study characteristics, migraine outcomes, adverse events and recurrence. The quality of evidence was assessed using the GRADE approach. The review protocol was prospectively registered on the PROSPERO database (CRD42017068577).

Results: The search strategy identified 789 articles; of them, 18 studies (4 RCTs and 14 case series) were eligible for analysis. Surgical interventions were heterogeneous and variably involved peripheral nerve decompression by myectomy or foraminotomy, nerve excision, artery resection and/or nasal surgery. All studies reported significant reductions in migraine intensity, frequency, duration and composite headache scores following surgery. Study heterogeneity precluded formal meta-analysis. Where reported, adverse event rates varied markedly between studies. The quality of included studies was consistently low or very low.

Conclusion: There is insufficient evidence to support the effectiveness of any specific surgical intervention for chronic migraine, especially with regard to permanent relief; however, all included studies report improvements in key outcomes following migraine surgery. A definitive, well-powered RCT with objective surgical and patient-reported outcome measures and robust adverse event reporting is required.

Keywords: Chronic migraine; Migraine; Migraine surgery.

PubMed Disclaimer

Figures

Figure 1.
Figure 1
PRISMA flowchart of study attrition.
See this image and copyright information in PMC

References

    1. Woldeamanuel Y.W., Cowan R.P. Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci. 2017;372:307–315. - PubMed
    1. Akerman S., Romero-Reyes M., Holland P.R. Current and novel insights into the neurophysiology of migraine and its implications for therapeutics. Pharmacol Ther. 2017;172:151–170. - PubMed
    1. Wild S., Roglic G., Green A. Global prevalence of diabetes. Diabetes Care. 2004;27(5):1047. - PubMed
    1. World Health Organisation (WHO): Chronic respiratory diseases - Asthma. Secondary WHO: Chronic respiratory diseases - Asthma 2016. http://www.who.int/respiratory/asthma/en/
    1. D'Amico D.L.M., Grazzi L., Bussone G. When should “chronic migraine” patients be considered “refractory” to pharmacological prophylaxis? Neurol Sci. 2008;29:55–58. - PubMed

LinkOut - more resources