American Society for Peripheral Nerve

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Comparison of Surgical Outcome in Patients Selected for Migraine Headache Surgery Using Nerve Blocks versus Botulinum Toxin
Nancy Wong, MD; Stacy Wong, BS; Mehdi Ansarinia, MD; Kayvan T. Khiabani, MD
University of Nevada School of Medicine, Las Vegas, NV, USA

Background: Millions of Americans are affected by migraine headaches (MHs) and there are patients who remain refractory to standard pharmacologic therapy. Surgical decompression of nerves in migraine trigger sites has recently been performed, resulting in significant improvement and in some cases even complete elimination of symptoms of migraine headaches. Current protocol requires a strict pre-selection of patients based on their response to botulinum toxin injections. Anesthetic nerve blocks, which have a better safety profile, quicker onset and a significantly lower cost, have been used by neurologists for diagnosis and treatment of patients with MHs. The purpose of this study is to determine if there is a difference in surgical efficacy between patients who were selected for surgery using botulinum toxin injections versus those who were selected using nerve blocks.

Methods: A retrospective chart review was performed for 35 patients who were diagnosed with chronic migraine headaches and underwent greater occipital nerve decompression surgery. This cohort was divided into 2 groups, those who were selected for migraine headache surgery using greater occipital nerve blocks and those who were selected using botulinum toxin injections of the area surrounding the greater occipital nerve. The patients were then contacted by phone to participate in a brief questionnaire regarding their migraine headache frequency, duration, and intensity before and after surgery in order to determine the migraine headache index (MHI).

Significant improvement (decrease in MHI or any of its components by at least 50%) was considered a successful surgical outcome.

Results: 11 (79%) out of 14 patients who were selected for surgery using nerve blocks experienced significant improvement while 4 (36%) of those patients experienced complete elimination of MHs. In the botulinum toxin group, 17 (81%) out of 21 patients experienced significant improvement, while 6 (35%) of those patients experience complete elimination of MHs. The success rate of greater occipital nerve decompression surgery in the nerve block group was not significantly different than the success rate of the botulinum toxin group (p=0.8).

Conclusions: There was no significant difference in the successful outcome of patients who were selected for MH surgery using nerve blocks versus botulinum toxin injections. Anesthetic nerve blocks performed by referring neurologists may be an adequate diagnostic tool in identifying candidates for migraine headache surgery.


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