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
. 2023 Sep 30:38:152-162.
doi: 10.1016/j.jpra.2023.09.009. eCollection 2023 Dec.

Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study

Jeffrey E Janis  1 , Jason Hehr  1 , Maria T Huayllani  1 , Ibrahim Khansa  1 , Lisa Gfrerer  2 , Kaitlin Kavanagh  1 , Pamela Blake  3   4 , Yevgeniya Gokun  5 , William G Austen Jr  2
Affiliations

Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study

Jeffrey E Janis et al. JPRAS Open. .

Abstract

Introduction: Chronic migraine headaches (MH) are a principal cause of disability worldwide. This study evaluated and compared functional outcomes after peripheral trigger point deactivation surgery or botulinum neurotoxin A (BTA) treatment in patients with MH.

Methods: A long-term, multicenter, and prospective study was performed. Patients with chronic migraine were recruited at the Ohio State University and Massachusetts General Hospital and included in each treatment group according to their preference (BTA or surgery). Assessment tools including the Migraine Headache Index (MHI), Migraine Disability Assessment Questionnaire (MIDAS) total, MIDAS A, MIDAS B, Migraine Work and Productivity Loss Questionnaire-question 7 (MWPLQ7), and Migraine-Specific Quality of Life Questionnaire (MSQ) version 2.1 were used to evaluate functional outcomes. Patients were evaluated prior to treatment and at 1, 2, and 2.5 years after treatment.

Results: A total of 44 patients were included in the study (surgery=33, BTA=11). Patients treated surgically showed statistically significant improvement in headache intensity as measured on MIDAS B (p = 0.0464) and reduced disability as measured on MWPLQ7 (p = 0.0120) compared to those treated with BTA injection. No statistical difference between groups was found for the remaining functional outcomes. Mean scores significantly improved over time independently of treatment for MHI, MIDAS total, MIDAS A, MIDAS B, and MWPLQ 7 (p<0.05). However, no difference in mean scores over time was observed for MSQ.

Conclusions: Headache surgery and targeted BTA injections are both effective means of addressing peripheral trigger sites causing headache pain. However, lower pain intensity and work-related disabilities were found in the surgical group.

Keywords: Botulinum neurotoxin A; Functional outcomes; MHI; MIDAS; MSQ; MWPLQ; Migraine headache; Migraine surgery.

PubMed Disclaimer

Conflict of interest statement

Dr. Janis receives royalties from Springer Publishing and Thieme Publishers. Dr. Austen Jr. receives royalties from Cytrellis biosystems, Durvena, Volumina, Arctic Fox, and Sientra. Drs. Hehr, Huayllani, Khansa, Gfrerer, Kavanagh, Blake, and Ms. Gokun have nothing to disclose.

References

    1. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–1222. - PMC - PubMed
    1. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954–976. - PMC - PubMed
    1. Ashina M. Migraine. N Engl J Med. 2020;383(19):1866–1876. - PubMed
    1. Calandre E.P., Hidalgo J., García-Leiva J.M., Rico-Villademoros F. Trigger point evaluation in migraine patients: An indication of peripheral sensitization linked to migraine predisposition? Eur J Neurol. 2006;13(3):244–249. - PubMed
    1. Olesen J. Clinical and pathophysiological observations in migraine and tension-type headache explained by integration of vascular, supraspinal and myofascial inputs. Pain. 1991;46(2):125–132. - PubMed

LinkOut - more resources