Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes.

Background: Low efficacy, significant side effects, and refractory patients often limit the medical treatment of migraine headache. However, new surgical options have emerged. Dr. Bahman Guyuron and others report response rates between 68 and 95 percent after surgical deactivation of migraine trigger sites in select patients. In an effort to replicate and expand migraine trigger-site deactivation surgery as a treatment option, the authors' group and others have developed nonendoscopic algorithms. The exclusion of endoscopic techniques may be useful for surgeons with little experience or limited access to the endoscope and in patients with challenging anatomy.

Methods: Forty-three consecutive trigger deactivation procedures in 35 patients were performed. Preoperative and 12-month postoperative migraine questionnaires and patient charts were reviewed. Response to surgery in terms of migraine symptom relief and adverse events were evaluated.

Results: The overall positive response rate was 90.7 percent. Total elimination of migraine headaches was reported in 51.3 percent of those with a positive response, greater than 80 percent resolution of symptoms was reported in 20.5 percent, and 28.2 percent had resolution between 50 and 80 percent. No significant effect was reported following 9.3 percent of procedures. There were no major adverse events.

Conclusions: Nonendoscopic trigger deactivation is a safe and effective treatment in select migraine headache patients. Although surgical techniques and understanding of the mechanisms of relief are evolving, results continue to be promising. This series confirms that excellent results can be attained without the endoscope. The authors continue to study these patients prospectively to improve patient selection and refine the protocol.

Clinical Question/level Of Evidence: Therapeutic, IV.