The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache

Abstract

Background: Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias. Methods: A systematic review was conducted to study the efficacy of decompression of extracranial sensory nerves as a treatment for neuralgia. Clinical studies were included that studied patients, aged 18 years or older, diagnosed with any definition of headache and were treated with extracranial nerve decompression surgery. Outcome parameters included intensity (on a 10-point scale), duration (in days), and frequency (of headaches per month). Results: Thirty-eight articles were found describing extracranial nerve decompression in patients with headaches. Postoperative decrease in headache intensity ranged from 2 to 8.2, reduction of duration ranged from 0.04 to 1.04 days, and reduction in frequency ranged between 4 and 14.8 headaches per month. Total elimination of symptoms was achieved in 8.3 to 83 percent of cases. A detailed summary of the outcome of single-site decompression is described. Statistical pooling and therefore meta-analysis was not possible, because of articles having the same surgeon and an overlapping patient database. Conclusions: Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.

“Migraine Surgery and Determination of Success Over Time by Trigger Site: A Systematic Review of the Literature”

“…10,11 Deactivation of these peripheral trigger sites has been shown to improve symptoms. [12][13][14][15][16][17][18][19][20] Despite significant results after surgery, the differences in success rates and the subjective report of surgical outcomes in some studies have limited evaluation of its efficacy. Many of these patients undergo deactivation of nerves in multiple trigger sites; thus, determination of surgery success by specific trigger site has been difficult to report.…”

Nonsurgical Treatment of Neuralgia and Cervicogenic Headache: A Systematic Review and Meta-analysis

“…The recent literature shows that this procedure constitutes an effective treatment for types of headaches with an extracranial origin, and success rates between 68% and 95% are reported. 7 Before patients with these types of headaches are considered for surgical treatment, they are offered nonsurgical treatment options. 1 There are various nonsurgical treatments, including oral treatment and injection therapy.…”

“…[11][12][13] The recent literature provides the outcomes of surgical decompression in patients with headaches. 6,7 However, a review describing the efficacy of the nonsurgical treatment of patients is lacking. Therefore, this article aims to overview the current literature on the nonsurgical treatment options and evaluate the effectiveness of these treatments in patients with neuralgia and cervicogenic headaches.…”

Outcomes of Surgical Treatment of Migraines: A Systematic Review & Meta-Analysis

“…Several recent systematic reviews and meta-analyses have concluded that nerve decompression is effective in treating certain populations of individuals with headaches. 15–18 1 review assessed surgical methods, finding that nerve decompression provided greater success rates than nerve stimulation which was in turn greater than radiofrequency ablation. 18 Other meta-analyses have summarized the outcome of headache elimination, reporting that the % of individuals with headache elimination ranges from 8.3% to 76% 16 and 8.3% to 83%.…”

“…18 Other meta-analyses have summarized the outcome of headache elimination, reporting that the % of individuals with headache elimination ranges from 8.3% to 76% 16 and 8.3% to 83%. 17 A third meta-analysis which also assessed the proportion of individuals with headache elimination reported a pooled proportion of 38% of individuals experience migraine elimination, although when assessing only randomized controlled trials the proportion was 21.46%. 15 Additionally, the proportion of individuals who experienced no relief of symptoms following surgery ranged from 3.9% to 33.3%.…”