Table 3.
Outcomes of Surgical Deactivation of Frontal Trigger Site Migraine
| Study | Sample (patients) | Outcomes Measurements | Follow-up (mo) | Results | Complications |
|---|---|---|---|---|---|
| Guyuron et al7 | 39 | – | 46.5 | 79.5% positive response 38.4% → elimination 41% → significant improvement |
–Paresthesia –Eyebrow asymmetry –Frontalis muscle paralysis |
| Dirnberger28 | 60 | % reduction of MH days, drugs, side effects, and severity of MH Patient satisfaction using a scale from 1 to 5 (1 = elimination; 5 = any change) |
6 and 18 | 68.3% positive response 28.3% → elimination 40% →significant improvement 31.7% → minimal or no change |
Paraesthesia, disappeared in all patients within 3–9 months. |
| Bearden and Anderson29 | 12 | Onset, frequency, severity, and duration of MH episodes; headache medications; and botulinum toxin |
6–19 | 92% →improvement | Any |
| Guyuron et al30 | 29 Actual surgery 19 Sham surgery 10 |
–Migraine Disability Assessment –MSQEM –Medical Outcomes Study 36-Item Short Form Health Survey |
12 |
Baseline actual surgery versus sham surgery: –Frequency: 9.8 versus 7.6–Intensity: 5.9 versus 6.1 –Duration: 0.56 versus 1.1–MHI: 24.3 versus 27.5 –MSQEM: 48.8 versus 37.2–Study 36-Item –Short Form Health Survey: 45.4 versus 46.7 1 year postoperative actual surgery versus sham surgery–Frequency: 6.37 (P < 0.001) versus 1.5 (P < 0.18) –Intensity: 2.5 (P = 0.005) versus 2.1 (P = 0.51) –Duration: 0.24 (P = 0.01) versus 0.18 (P = 0.57) –MHI: 15.4 (P = 0.003) versus 12.2 (P = 0.03) –MSQEM: 24 (P = 0.02) versus 0.46 (P = 0.97) –36-Item Short Form Health Survey: 5.9 (P = 0.002) versus 1.5 (P = 0.51) |
–Temporary intense pruritus →11% –Uneven brow movement →5% –Residual corrugator muscle function →5% |
| de Ru et al31 | 10 | Pain severity scoring verbal numerical rating scale (NRS): from 0 (no pain) to 10 (severe pain) |
3–30 | 90% → lowered pain score (from 8.1 to 0.8) 10% → any change |
Numbness in 3 patients Paresthesia and hematoma formation in 1 patient |
| Chepla et al32 | 86 | MH severity, frequency, and duration MHI Forehead pain |
12 |
Glabellar myectomy versus Glabellar myectomy + supraorbital foraminotomy Postoperative migraine frequency: 7.8 versus 4.1 per month Severity: 5.6 versus 4.4 MHI: 26.5 versus 11.1 Persistent forehead pain: 48.8% versus 25.6% |
Not reported |
| Lee et al33 | 132 | MHI (success defined as >50% of reduction) 2 groups: a) preoperative BTA responsive (109 patients) b) preoperative BTA NON responsive (23 patients) |
>12 |
Total: 83.3% → positive response 56.8% → elimination 26.5 → >50% reduction BTA responsive versus BTA NON responsive group: Migraine elimination: 33.7% versus 7.6% >50% reduction: 92.5% versus 69.2% |
Not reported |
| Liu et al34 | 35 | MH frequency, duration and intensity |
12–126 (mean: 34) |
77% → positive response | Not reported |
| Caruana et al35 | 54 Age range: 18–75 y |
36-item short questionnaire (before surgery) 29-item short questionnaire (6 months and 2 years after surgery) |
24 |
6 months (51 patients): 84.3% → positive response 41.2% → elimination 43.1% → significant improvement 2 years (29 patients): 89.6% → positive response 31% → complete elimination 58.6% → significant improvement |
Not reported |
| Caruana et al36 | 16 | Headache questionnaire | – | 81.5% → positive response 31.5% → elimination 50% → significant improvement |
Not reported |
| Polotto et al37 | 43 | Headache questionnaire | 24 | 93.3% → positive response to the surgery: 33.3% → complete elimination 60% → significant improvement |
Not reported |
| Raposio and Caruana38 | 43 | Headache questionnaire | 6 and 24 |
6-month-long follow-up (43 patients): 81.4% → positive response 39.5% → elimination 41.9% → significant improvement 2-year-long follow-up (15 patients): 93.3% →positive response 33.3% → elimination 60% →significant improvement |
Not reported |
| Kurlander et al39 | 34 | Frontal-specific MHI Reduction in migraine days (duration × frequency) |
12 | 88% → positive response 59% → elimination |
Numbness →32.1% Pruritus →8.9% Hypersensitivity →8.9% Eyelid Ptosis →3.6% |
| Punjabi et al40 | 185 | Migraine headache questionnaire | 13 | 17.8% of the cohort reported new postoperative migraines Site I: 20.83% → Site III (septo-nasal) unmasked after surgery |
Not reported |
| Gatherwright et al41 | 13 | Migraine headache severity and duration MHI MFDs |
21.6 (7.6–34.1) | MHI: from 52.6 (3.8–85) to 4.7(0–21.3), P = 0.0001Arterectomy group (9 patients): MHI: from 51.71 to 5.55 Frequency: 12 versus 6.11 Improvement MFDs: from 18 to 24 No arterectomy (4 patients): Improvement MFDs: 13.25 Less than arterectomy group (13.25 versus 24 MFDs): 31% required a site I revision that included an arterectomy. Following revision, both groups had statistically equivalent improvement in MFDs (20.75 versus 24 MFDs) |
Not reported |
| Filipovic et al42 | 22 | Daily headache diary (4 points only) Headache questionnaire |
12–107 (mean: 29.5) | VAS headache intensity from 8.10 to 1.3 at 3 months after surgery and to 1.09 at 12 months after surgery Accompanying headache symptoms (photophobia, phonophobia, nausea, and vomiting) were completely abolished in all patients, except in 1 case |
–Transient paresthesia → 2 patients (3 months duration) –Temporary hair loss above the incision → 1 patient (12 months duration) |
| Fallucco et al43 | 30 | – | – | –Supraorbital foramen → 26.6% of cases –Supraorbital notch → 83.3% of cases –Fascial band → 86% of supraorbital region that contained a notch and classified into 3 types |
– |
| Ortiz et al44 | 61 | – | – | –Supraorbital foramen → 41% of cases –Supraorbital notch → 49% of cases –Supraorbital foramen and notch → 9.3% of cases SON (66%) or STN (29%) Compression → 95% of cases. Nerve edema, flattening, or discoloration → 74% |
– |
BTA, botulinum toxin type A; MFD, migraine-free days; MSQEM, Migraine-Specific Quality of Life.