Frontal site surgery for chronic migraine therapy

Frontal site surgery for chronic migraine therapy

Authors

  • Giorgio Raposio Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy
  • Andrea Antonini Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy
  • Alessandro Gualdi San Raffaele University, Milan, Italy
  • Edoardo Raposio Genova - Chirurgia Plastica Ricostruttiva ed Estetica - Terapia Cura Emicrania Cefalea.

Keywords:

Migraine treatment;, migraine surgery;, frontal nerves, mini-invasive surgery

Abstract

Background: According to the most current theories, chronic inflammation of some cranial nerves give rise to an inflammatory chain that would result in migraines. As for frontally located attacks, the nerves involved are two (on each side): the supraorbital and the supratrochlear. Surgical treatment includes complete neurolysis of both of these nerves.

Methods: In this work, we describe our experience with this type of surgery. From 2011 to 2022, we treated 98 cases suffering from chronic migraine not responsive to drugs with frontal localization. The results were evaluated through a specific questionnaire three months and one year after surgery.

Results: After three months post-surgery, we observed a success rate (reduction of monthly attacks equivalent to or greater than 50%) in 87% of patients (32% complete recovery). These results were essentially confirmed one year after surgery. The rare complications (mainly paresthesias and dysesthesias of the frontal area) have always resolved spontaneously within a few months.

Conclusion: The surgical approach allowed to obtain good therapeutic results with a low rate of complications.

References

Chen ST, Schoenbrunner A, Gfrerer L, et al. Estrogen-Associated Headaches Can Be Treated by Surgery: A Multicenter Retrospective Cohort Study. (2022) Plast Reconstr Surg, 150 (4), 854E-862E. doi: 10.1097/PRS.0000000000009546.

Peled ZM, Pietramaggiori G, Scherer S. Anatomic and Compression Topography of the Lesser Occipital Nerve. Plast Reconstr Surg Glob Open. 2016 Mar 17;4(3):e639. doi: 10.1097/GOX.0000000000000654.

Gfrerer L, Chartier C, Lans J, Eberlin KR, Austen WG. A Correlation between upper extremity compressive Neuropathy and Nerve compression headache. 2021. Plast Reconstr Surg, 148 (6), 1308-1315. doi: 10.1097/PRS.0000000000008574.

Ortiz R, Gfrerer L, Panzenbeck P, Hansdorfer MA, Austen WG. Trigger Site Deactivation Surgery for Headaches is Associated with Decreased Postoperative Medication Use. 2021. Plast Reconstr Surg - Global Open, 9 (6), E3634. doi: 10.1097/GOX.0000000000003634.

Peled ZM. A Novel Surgical Approach to Chronic Temporal Headaches. Plast Reconstr Surg. 2016 May;137(5):1597-1600. doi: 10.1097/PRS.0000000000002051.

Gfrerer L, Dayan E, Austen WG. Trigger-site deactivation surgery for nerve compression headaches. 2021. Plast Reconstr Surg, 1004E-1021E. doi: 10.1097/PRS.0000000000007931.

Ortiz R, Gfrerer L, Hansdorfer MA, et al. The Efficacy of Surgical Treatment for Headaches in Patients with Prior Head or Neck Trauma. 2020. Plast Reconstr Surg 146 (2): 381-388. doi: 10.1097/PRS.0000000000007019.

Bertozzi N, Simonacci F, Lago G, Bordin C, Raposio E. Surgical therapy of temporal triggered migraine headache. Plast Reconstr Surg Glob Open 2018; 6: e1980. doi: 10.1097/GOX.0000000000001980.

Baldelli I, Mangialardi ML, Raposio E. Site V surgery for temporal migraine headaches. Plast Reconstr Surg Glob Open 2020; 8: e2886. doi: 10.1097/GOX.0000000000002886.

Raposio G, Raposio E. Temporal surgery for chronic migraine treatment: A minimally-invasive perspective. Ann Med Surg, 2022, 76, 103578. doi: 10.1016/j.amsu.2022.103578.

Raposio G, Cortese K, Raposio E. An easy and reliable way to preoperatively identify the auriculo-temporal nerve in Migraine Surgery. JPRAS. 2022. doi: 10.1016/j.bjps.2022.04.029.

Raposio E, Caruana G. Tips for the surgical treatment of occipital nerve-triggered headaches. Eur J Plast Surg. 2017.40(3):177-182. doi: 10.1007/s00238-016-1249-8.

Bertozzi N, Simonacci F, Lago G, Bordin C, Raposio E. Surgical therapy of temporal triggered migraine headache. Plast Reconstr Surg Glob Open. 2018 Dec 17;6(12):e1980. doi: 10.1097/GOX.0000000000001980. eCollection 2018 Dec.

Raposio E, Bertozzi N. Trigger site inactivation for the surgical therapy of occipital migraine and tension-type headache: Our experience and review of the literature. Plast Reconstr Surg Glob Open. 2019;7:e2507. doi: 10.1097/GOX.0000000000002507.

Simonacci F, Raposio E. Surgical deactivation of occipital migraine trigger site. Chirurgia (Turin). 2020, 33(3): 143 - 149. doi: 10.23736/S0394-9508.19.05027-7.

Totonchi A, Guyuron B, Ansari H. Surgical Options for Migraine: An Overview. Neurol India. 2021 Mar-Apr;69(Supplement):S105-S109. doi: 10.4103/0028-3886.315999.

Jubbal KT, Zavlin D, Echo A. Optimizing Exposure for the Occipital Nerve in Migraine Surgery while Maintaining Hair Length. Plast Reconstr Surg Glob Open. 2017 Nov 9;5(11):e1518. doi: 10.1097/GOX.0000000000001518.

Lin SH, Lin HC, Jeng CH, et al. Experience of Surgical Treatment for Occipital Migraine in Taiwan. Ann Plast Surg. 2016 Mar;76 Suppl 1:S80-4. doi: 10.1097/SAP.0000000000000697.

Lee M, Lineberry K, Reed D, Guyuron B. The role of the third occipital nerve in surgical treatment of occipital migraine headaches. J Plast Reconstr Aesthet Surg. 2013 Oct;66(10):1335-1339. doi: 10.1016/j.bjps.2013.05.023.

Vincent AJPE, van Hoogstraten WS, Maassen Van Den Brink A, ET AL. Extracranial Trigger Site Surgery for Migraine: A Systematic Review With Meta-Analysis on Elimination of Headache Symptoms. Front Neurol. 2019 Feb14;10:89. doi: 10.3389/fneur.2019.00089.

Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B. In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV). Plast Reconstr Surg. 2017 Jun;139(6):1333e-1342e. doi: 10.1097/PRS.0000000000003395.

Gfrerer L, Raposio E, Ortiz R, Austen WG Jr. Surgical Treatment of Migraine Headache: Back to the Future. Plast Reconstr Surg. 2018 Oct;142(4):1036-1045. doi: 10.1097/PRS.0000000000004795.

Amaya-Blas FJ, Mecott GA, Marfil-Rivera A, et al. Effectiveness of surgical treatment in chronic migraine. Cir Cir. 2019;86(1):90-95. doi: 10.24875/CIRUE.M18000014.

Dash KS, Janis JE, Guyuron B. The lesser and third occipital nerves and migraine headaches. Plast Reconstr Surg. 2005 May;115(6):1752-1758; discussion 1759-1760. doi: 10.1097/01.prs.0000161679.26890.ee.

Ducic I, Hartmann EC, Larson EE. Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia. Plast Reconstr Surg. 2009 May;123(5):1453-1461. doi: 10.1097/PRS.0b013e3181a0720e.

Poggi JT, Grizzell BE, Helmer SD. Confirmation of surgical decompression to relieve migraine headaches. Plast Reconstr Surg. 2008 Jul;122(1):115-122. doi: 10.1097/PRS.0b013e31817742da.

Lee M, Brown M, Chepla K, et al. An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches. Plast Reconstr Surg. 2013 Dec;132(6):1551-1556. doi: 10.1097/PRS.0b013e3182a80721.

Baldelli I, Mangialardi ML, Salgarello M, Raposio E. Peripheral occipital nerve decompression surgery in migraine headache. Plast Reconstr Surg Glob Open. 2020;8:e3019. doi: 10.1097/GOX.0000000000003019.

Raposio G, Raposio E. Surgical therapy of occipital (Arnold) neuralgia: A case series. Ann Med Surg, 2022, 80, 104237. doi: 10.1016/j.amsu.2022.104237.

Peled ZM, Pietramaggiori G, Scherer S. Anatomic and Compression Topography of the Lesser Occipital Nerve. Plast Reconstr Surg Glob Open. 2016 Mar 17;4(3):e639. doi: 10.1097/GOX.0000000000000654.

Junewicz A, Katira K, Guyuron B. Intraoperative anatomical variations during greater occipital nerve decompression. J Plast Reconstr Aesthet Surg. 2013 Oct;66(10):1340-1345. doi: 10.1016/j.bjps.2013.06.016.

Eskilsson A, Ageberg E, Ericson H, Marklund N, Anderberg L. Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain - a retrospective cohort study. Acta Neurochir (Wien). 2021 Sep;163(9):2425-2433. doi: 10.1007/s00701-021-04913-0.

Ortiz R, Gfrerer L, Hansdorfer MA, et al. Migraine Surgery at the Frontal Trigger Site: An Analysis of Intraoperative Anatomy. 2020. Plast Reconstr Surg 145 (2): 523-530. doi: 10.1097/PRS.0000000000006475.

Gualdi A, Cambiaso-Daniel J, Gatti J, et al. Selective denervation of the corrugator supercilii muscle for the treatment of idiopatic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and suprathrochlear dermatomes. Headache Pain. 2021; 4;22(1):9. doi: 10.1186/s10194-021-01218-6.

Raposio E, Raposio G. Surgical therapy of migraine: a 12-year single-center experience. Eur J Plast Surg. 2023;46:699–705. doi: 10.1007/s00238-023-02065-1.

Amirlak B, Chung H, Pezeshk RA, Sanniec K. Accessory Nerves of the Forehead: A Newly Discovered Frontotemporal Neurovascular Bundle and Its Implications in the Treatment of Frontal Headache, Migraine Surgery, and Cosmetic Temple Filler Injection. 2018. Plast Reconstr Surg, 141 (5), 1252-1259. doi: 10.1097/PRS.0000000000004320.

Filipović B, de Ru JA, van de Langenberg R, et al. Decompression endoscopic surgery for frontal secondary headache attributed to supraorbital and supratrochlear nerve entrapment: a comprehensive review. (2017) European Archives of Oto-Rhino-Laryngology, 274 (5), 2093-2106. doi: 10.1007/s00405-017-4450-x.

Raposio E, Simonacci F. Frontal trigger site deactivation for migraine surgical therapy. Plast Reconstr Surg Glob Open 2020; 8: e2813. doi: 10.1097/GOX.0000000000002813.

Mangialardi ML, Baldelli I, Salgarello M, Raposio E. Decompression surgery for frontal migraine treatment. Plast Reconstr Surg Glob Open 2020; 8: e3084. doi: 10.1097/GOX.0000000000003084.

Caruana G, Bertozzi N, Boschi E, et al. Endoscopic forehead surgery for migraine therapy Personal technique. Ann Ital Chir 2014; 85: 583-586. ISSN: 2239253X. PMID: 25711848.

Caruana G, Grignaffini E, Raposio E. Endoscopic forehead muscle resection for nerve decompression: a modified procedure. Plast Reconstr Surg Glob Open 2015; 3: e342. doi: 10.1097/GOX.0000000000000308.

Raposio E, Caruana G. Frontal endoscopic myotomies for chronic headache. J Craniofac Surg 2015; 3: e201-e203. doi: 10.1097/SCS.0000000000001353.

Polotto S, Simonacci F, Grignaffini E, Grieco MP, Raposio E. Surgical treatment of frontal and occipital migraines: A comparison of results. Plast Reconstr Surg Glob Open 2016; 4: e653. doi: 10.1097/GOX.0000000000000631.

Raposio G, Raposio E. Principles and techniques of migraine surgery. Eur Rev Med Pharmacol Sci, 2022; 26: 6110-6113. doi: 10.26355/eurrev_202209_29628.

Cortese K, Tagliatti E, Gagliani MC, et al. Ultrastructural imaging reveals vascular remodeling in migraine patients. Histochem Cell Biol. 2022 Apr;157(4):459-465. doi: 10.1007/s00418-021-02066-w.

Raposio E, Raposio G, Del Duchetto D, Tagliatti E, Cortese K. Morphologic Vascular Anomalies detected during Migraine Surgery. JPRAS. 2022, doi: 10.1016/j.bjps.2022.08.036.

Guyuron B, Son JH. Transpalpebral Corrugator Resection: 25-Year Experience, Refinements and Additional Indications. 2017. Aesth Plast Surg, 41 (2), 339-345. doi: 10.1007/s00266-017-0780-8.

Raposio E. “Atlas of Endoscopic Plastic Surgery”. Springer, New York, USA, 2015.

Raposio E. “Atlas of Surgical Therapy for Migraine and Tension-Type Headache”. Springer, New York, USA, 2019.

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Published

05-12-2023

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Section

ORIGINAL CLINICAL RESEARCH

How to Cite

1.
Raposio G, Antonini A, Gualdi A, Raposio E. Frontal site surgery for chronic migraine therapy. Acta Biomed [Internet]. 2023 Dec. 5 [cited 2024 Jul. 17];94(6):e2023253. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/14777