Trigger Site Deactivation Surgery for Chronic Headaches: An Investigation Into Postoperative Outcomes
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CitationOrtiz, Ricardo. 2020. Trigger Site Deactivation Surgery for Chronic Headaches: An Investigation Into Postoperative Outcomes. Doctoral dissertation, Harvard Medical School.
AbstractBackground: Chronic migraine is a debilitating condition that affects millions of patients. Trigger site deactivation surgery has evolved as an effective treatment for some patients living with refractory chronic headache pain. To improve patient selection and preoperative counseling for surgery, it is critical to understand the expected outcomes of surgery. This study aims to investigate the postoperative outcomes of trigger site deactivation surgery and explore if any preoperative variables, such as history of head injury or pain patterns, are predictive of postoperative results.
Methods: 142 patients undergoing trigger site deactivation surgery were prospectively enrolled. Preoperatively, patients were asked to complete a questionnaire on headache history, including the Migraine Headache Index (MHI), information on prior head or neck injury, medication history, and psychiatric comorbidities. Patients were also asked to illustrate their pain using standardized pain pattern forms. Diagrams were analyzed and categorized by two independent, blinded reviewers: 1) Typical- pain over the distribution of a nerve with expected radiation 2) Intermediate- pain over the distribution of the nerve with atypical radiation 3) Atypical- pain outside of normal nerve distribution and atypical radiation. The senior author performed all surgical procedures. Follow up surveys were sent to all patients at twelve months postoperatively.
Results: Of the subjects included in this study, 50% (n=71) reported a history of head or neck injury, and 30% (n=42) classified the injury as the precipitating event leading to their MH. There was no significant difference in mean preoperative migraine symptoms between patients with an injury versus those without. At twelve months postoperatively, there was a significant decrease in migraine symptoms, medication use, and depressive symptoms. There was no significant difference in postoperative migraine symptoms among patients with head or neck injury versus those without. Patients with atypical pain patterns had significantly poorer postoperative outcomes than patients with typical and intermediate pain patterns.
Conclusions: This study provides several in-depth analyses on the postoperative outcomes of trigger site deactivation surgery and variables which affect postoperative outcomes. We demonstrated that 1) patients with head or neck injury achieve successful postoperative outcomes, 2) atypical pain patterns are associated with inferior outcomes, and 3) surgery is associated with decreased medication use and improved depressive symptoms. It is important for surgeons to be aware of this data as we continue to refine our approach to trigger site deactivation surgery.
Citable link to this pagehttps://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37365201