Surgery for migraine unresponsive to medication
Summary of the results
Number who experienced at least a 50% reduction in migraine headache frequency
Actual surgery: 83.7%
Sham surgery (‘placebo’): 57.7%
Complete elimination of migraine headaches
Actual surgery: 57.1%
Sham surgery (‘placebo’): 3.8%
Comment:
The number of patients receiving the surgical procedure (49) is rather small. Nonetheless, this study suggests that for those with significant disability secondary to migraine that is unresponsive to more conservative therapy, surgery might be considered.
The publication:
August, 2009
A placebo-controlled surgical trial of the treatment of migraine headaches.
Summary of the abstract
Many of the nearly 30 million Americans suffering with migraine headaches are not helped by standard therapies.
Seventy-five patients with moderate to severe migraine headache were studied. Trigger sites were identified (frontal, temporal, and occipital), and patients were randomly assigned to receive either actual or sham surgery. Follow-up was at one year.
RESULTS: Of the total group of 75 patients, 15 of 26 in the sham surgery group (57.7 percent) and 41 of 49 in the actual surgery group (83.7 percent) experienced at least 50 percent reduction in migraine headache (p < 0.05).
Furthermore, 28 of 49 patients in the actual surgery group (57.1 percent) reported complete elimination of migraine headache, compared with only one of 26 patients in the sham surgery group (3.8 percent) (p < 0.001).
Compared with the control group, the actual surgery group demonstrated statistically significant improvements in all validated migraine headache measurements at 1 year. These improvements were not dependent on the trigger site. The most common surgical complication was slight hollowing of the temple in the group with temporal migraine headache.
CONCLUSION: This study confirms that surgical deactivation of peripheral migraine headache trigger sites is an effective alternative treatment for patients who suffer from frequent moderate to severe migraine headaches that are difficult to manage with standard protocols.
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