Migraine surgery

Migraine surgery is any surgical operation undertaken with the goal of reducing or preventing migraines. It is considered by some as an alternative when other treatments are not effective. The American Headache Society has advised that no physician should recommend surgical deactivation of migraine trigger points other than in experimental clinical trials because no accurate estimates exist about the efficacy and harms of the surgery.^[1]

Uses

Migraine surgery involving deactivation of migraine trigger points is not indicated outside of experimental clinical trials because no accurate estimates exist about the efficacy and harms of the surgery.^[1] While some observational studies have suggested possible benefit, the amount of available evidence on migraine surgery does not provide accurate estimates of the surgery's efficacy or describe the harms it causes.^[1] Long-term side effects are unknown and could be problematic.^[1] The American Headache Society and others urge caution about this procedure.^[1]

Surgical procedures

Trigger sites

Surgically inactivating of trigger sites has been studied but the studies have issues.^[2] It is based on the belief that the cause of migraines is compression of peripheral nerves.^[3]

Patent foramen ovale closure

It is unclear if an open patent foramen ovale is or is not related to migraines with an aura.^[4][5] Data supporting an effect of closure on the rates of migraines is mostly of low quality.^[6] The only randomized trial did not find benefit.^[6]

References

1. American Headache Society (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Headache Society), retrieved 10 December 2013, which cites
   • Guyuron, B. K.; Kriegler, J. S.; Davis, J.; Amini, S. B. (Jan 2005). "Comprehensive surgical treatment of migraine headaches". Plastic and Reconstructive Surgery 115 (1): 1–9. doi:10.1097/01.PRS.0000145631.20901.84. PMID 15622223.
   • Guyuron, B.; Reed, D.; Kriegler, J. S.; Davis, J.; Pashmini, N.; Amini, S. (2009). "A Placebo-Controlled Surgical Trial of the Treatment of Migraine Headaches". Plastic and Reconstructive Surgery 124 (2): 461–468. doi:10.1097/PRS.0b013e3181adcf6a. PMID 19644260.
   • Guyuron, B.; Kriegler, J. S.; Davis, J.; Amini, S. B. (2011). "Five-Year Outcome of Surgical Treatment of Migraine Headaches". Plastic and Reconstructive Surgery 127 (2): 603–608. doi:10.1097/PRS.0b013e3181fed456. PMID 20966820.
   • American Headache Society (13 April 2012), American Headache Society Urges Caution in Using Any Surgical Intervention in Migraine Treatment, Mount Royal, New Jersey: American Headache Society, retrieved 18 December 2013
2. Mathew, PG (January 2014). "A critical evaluation of migraine trigger site deactivation surgery.". Headache 54 (1): 142–52. doi:10.1111/head.12218. PMID 24116941.
3. Kung, TA; Guyuron, B; Cederna, PS (January 2011). "Migraine surgery: a plastic surgery solution for refractory migraine headache.". Plastic and Reconstructive Surgery 127 (1): 181–9. doi:10.1097/prs.0b013e3181f95a01. PMID 20871488.
4. Morelli, N; Rota, E (2014). "Migraine and Patent Foramen Ovale: Barking up the Wrong Tree?". Frontiers in Neurology 5: 99. doi:10.3389/fneur.2014.00099. PMID 24982650.
5. Sathasivam, S; Sathasivam, S (April 2013). "Patent foramen ovale and migraine: what is the relationship between the two?". Journal of cardiology 61 (4): 256–9. doi:10.1016/j.jjcc.2012.12.005. PMID 23484805.
6. Lip, PZ; Lip, GY (May 2014). "Patent foramen ovale and migraine attacks: a systematic review.". The American Journal of Medicine 127 (5): 411–20. doi:10.1016/j.amjmed.2013.12.006. PMID 24355354.