Surgical Treatment of Frontal and Occipital Migraines

Polotto, Susanna; Simonacci, Francesco; Grignaffini, Eugenio; Grieco, Michele Pio; Raposio, Edoardo

doi:10.1097/gox.0000000000000631

Cited by 23 publications

(15 citation statements)

References 7 publications

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“…From June 2011 until July 2019, we performed MH decompression surgeries in over 269 patients with either frontal, occipital, or temporal migraine trigger sites [2,[13][14][15][16][17][26][27][28].…”

Section: Resultsmentioning

confidence: 99%

“…As regards our experience [26][27][28], we performed the occipital decompression surgical technique with the patient prone, under local assisted anesthesia. After injecting 40-cc of diluted Carbocaine 1% + 40-cc NaCl 0.9% and 20-cc sodium bicarbonate 8.4%, two horizontal occipital scalp incisions 5 cm in length were performed along the superior nuchal line bilaterally, at the location of arterial signal detected preoperatively by portable Doppler.…”

Section: Occipital Trigger Sitementioning

confidence: 99%

“…In the remaining cases in which vascular compression was not found we adopted a more conventional approach based on neurolysis of the GON and LON by undermining the occipital, trapezius, splenius capitis and semispinalis capitis muscles and following the nerve course caudally as possible [26,27]. At the end of the procedure, after an accurate hemostasis, the cutaneous access was sutured with absorbable threads, without any drainage.…”

Section: Occipital Trigger Sitementioning

confidence: 99%

“…Temporary anesthesia occurred in all patients, which lasted 163 days on average [2,[13][14][15][16][17][26][27][28][29]. Minor and transient complications reported in literature are lasting occipital numbness, intense itching after surgery, hypertrophic scar, incisional cellulitis, transient mild incisional alopecia or hair thinning, lasting neck stiffness that have an incidence ranging from 1 to 5% [2,[13][14][15][16][17][26][27][28][29]. As regard our experience, intense itching after surgery was present in 30% of patients, temporary anesthesia in all patients while postoperative infections, seromas, or hematomas were not observed.…”

Section: Complicationsmentioning

confidence: 99%

“…The most common complication after site temporal migraine surgeries is slight hollowing of the temple (54% incidence rate). Nerve avulsion might be associated with neuroma formation, although it is not reported in literature of any neuroma following avulsion of ATN and/or ZTN [2,[13][14][15][16][17][26][27][28].…”

Section: Complicationsmentioning

confidence: 99%

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Minimally Invasive Surgical Treatment of Migraine

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Bertozzi²,

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et al. 2020

Migraine

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Migraine headache (MH) is a very common disorder affecting 10-12% of the world's adult population. The first line therapy for migraine is usually a combination of conservative treatments but some patients seem to be refractory. For this group of patients, the minimally invasive surgical treatment of migraine might offer a solution. Migraine is usually caused by extracranial sensitive nerve compression due vascular, fascial or muscular structures nearby. The aim of migraine surgery is to relieve such compression at specific trigger points located in the occipital, temporal and frontal regions. From June 2011 until July 2019, we performed MH decompression surgeries in over 269 patients with either frontal, occipital, or temporal migraine trigger sites. In the occipital and temporal areas, nerve decompression was achieved by occipital and superficial temporal artery ligation, respectively. In patients suffering from frontal headache we performed both endoscopic nerve decompression and transpalpebral decompression. Among patient suffering from occipital migraine, 95% of them showed improvement of their condition, with 86% reporting complete relief. As concern temporal migraine, positive outcome was achieved in 83% of the patients (50% complete elimination and 33% partial improvement). In patient suffering from frontal migraine, positive results were observed in 94% of the patients (32% complete elimination, 62% partial improvement). Migraine is a common and debilitating condition that can be treated successfully with minimally invasive surgical procedure especially for those patients non-responding to medical therapies.

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