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. 2023 May;31(2):192-205.
doi: 10.1177/22925503211036701. Epub 2021 Dec 21.

Outcomes of Surgical Treatment of Migraines: A Systematic Review & Meta-Analysis

Adam G Evans  1 , Dorian S Hill  1 , Andrew E Grush  1 , Mauricio A Downer Jr  1 , Maryo M Ibrahim  1 , Patrick E Assi  2 , Jeremy T Joseph  2 , Salam H Kassis  2
Affiliations

Outcomes of Surgical Treatment of Migraines: A Systematic Review & Meta-Analysis

Adam G Evans et al. Plast Surg (Oakv). 2023 May.

Abstract
in English, French

Background: Migraine surgery at 1 of 6 identified "trigger sites" of a target cranial sensory nerve has rapidly grown in popularity since 2000. This study summarizes the effect of migraine surgery on headache severity, headache frequency, and the migraine headache index score which is derived by multiplying migraine severity, frequency, and duration. Materials and Methods: This is a PRISMA-compliant systematic review of 5 databases searched from inception through May 2020 and is registered under the PROSPERO ID: CRD42020197085. Clinical trials treating headaches with surgery were included. Risk of bias was assessed in randomized controlled trials. Meta-analyses were performed on outcomes using a random effects model to determine the pooled mean change from baseline and when possible, to compare treatment to control. Results: 18 studies met criteria including 6 randomized controlled trials, 1 controlled clinical trial, and 11 uncontrolled clinical trials treated 1143 patients with pathologies including migraine, occipital migraine, frontal migraine, occipital nerve triggered headache, frontal headache, occipital neuralgia, and cervicogenic headache. Migraine surgery reduced headache frequency at 1 year postoperative by 13.0 days per month as compared to baseline (I2 = 0%), reduced headache severity at 8 weeks to 5 years postoperative by 4.16 points on a 0 to 10 scale as compared to baseline (I2 = 53%), and reduced migraine headache index at 1 to 5 years postoperative by 83.1 points as compared to baseline (I2 = 2%). These meta-analyses are limited by a small number of studies that could be analyzed, including studies with high risk of bias. Conclusion: Migraine surgery provided a clinically and statistically significant reduction in headache frequency, severity, and migraine headache index scores. Additional studies, including randomized controlled trials with low risk-of-bias should be performed to improve the precision of the outcome improvements.

Historique: Le traitement de la migraine à l’une des six « zones gâchettes » établies d’un nerf crânien sensoriel cible ont rapidement gagné en popularité depuis 2000. La présente étude résume l’effet du traitement chirurgical de la migraine sur la gravité et la fréquence des céphalées et sur le score de migraine obtenu par la multiplication de la gravité, de la fréquence et de la durée des migraines. Matériel et méthodologie: La présente analyse systématique de cinq bases de données fouillées depuis leur création jusqu’à mai 2020 respecte la liste PRISMA et est enregistrée sous le numéro d’identification CRD42020197085 de PROSPERO. Les chercheurs ont retenu les études cliniques sur le traitement des céphalées par des interventions chirurgicales. Ils ont évalué le risque de biais des études aléatoires et contrôlées. Ils ont également effectué des méta-analyses des résultats au moyen d’un modèle à effets aléatoires pour déterminer le changement moyen regroupé par rapport à l’état de référence et, dans la mesure du possible, pour comparer des sujets traités à des sujets témoins. Résultats: Au total, 18 études respectaient les critères, y compris six études aléatoires et contrôlées, une étude clinique contrôlée, et 11 études non contrôlées auprès de 1 143 patients ayant des pathologies incluant la migraine, la migraine occipitale, la migraine frontale, la céphalée occipitale, la céphalée frontale, la névralgie occipitale et la céphalée cervicogénique. Par rapport à l’état de départ, le traitement chirurgical de la migraine avait réduit la fréquence des céphalées de 13,0 jours par mois (I2 = 0%) un an après l’opération, la gravité des céphalées de 4,16 points sur une échelle de 0 à 10 de huit semaines à cinq ans après l’opération (I2 = 53%) et le score de migraine de 83,1 points de un à cinq ans après l’opération (I2 = 2%). Ces méta-analyses sont limitées par le petit nombre d’études pouvant être analysées, y compris des études comportant de forts risques de biais. Conclusion: Le traitement chirurgical de la migraine assure une diminution cliniquement et statistiquement significative de la fréquence et de la gravité des céphalées, ainsi que des scores de migraine. D’autres études, y compris des études aléatoires et contrôlées comportant un faible risque de biais, devront être exécutées pour mieux préciser les améliorations aux résultats cliniques.

Keywords: headache; migraine disorders; migraine surgery; neuralgia; reconstructive surgical procedures; treatment outcome.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Application of our search strategy identified 3516 records. After removal of duplicates, 2829 records were screened by title and abstract, leading to the exclusion of 2706 records. Full-text screen of 123 records led to the exclusion of 105 articles for reasons. Therefore, 18 articles were included in the systematic review and 9 articles in the meta-analyses.
Figure 2.
Figure 2.
Risk of bias assessment for randomized controlled trials resulted in 3 studies having low risk-of-bias, 1 study having unclear risk-of-bias, and 2 studies having high risk-of-bias. Red = high risk-of-bias. Yellow = unclear risk-of-bias. Green = low risk-of-bias.
Figure 3.
Figure 3.
Meta-analysis shows that following migraine surgery, the pooled mean reduction in migraine frequency at 1-year postoperative follow-up compared to baseline was 13.02 headache days per month.
Figure 4.
Figure 4.
Meta-analysis shows that following migraine surgery, the pooled mean reduction in migraine pain severity at 8 weeks to 5 years postoperative follow-ups compared to baseline was 4.16 points on a scale from 0 to 10.
Figure 5.
Figure 5.
Meta-analysis shows that at 1 month to 1 year, the treatment groups provided a greater reduction to headache intensity than the control groups.
Figure 6.
Figure 6.
Meta-analysis shows that following migraine surgery, the pooled mean reduction in migraine headache index score at 1 to 5 years postoperative follow-ups compared to baseline was 83.10 points.
See this image and copyright information in PMC

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