Effectiveness of surgical treatment in chronic migraine

Objetivos: La migrana cronica afecta a mas de 35 millones de personas en los EE.UU. y al 10% de la poblacion en Mexico. El objetivo de este estudio fue valorar la efectividad del tratamiento quirurgico en la migrana cronica con sitios detonantes frontal u occipital para proponerla como alternativa quirurgica en nuestro medio. Methods: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. Jose Eleuterio Gonzalez (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. Jose Eleuterio Gonzalez that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. Results: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. Conclusiones: El tratamiento quirurgico es efectivo en la migrana cronica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.