American Society for Peripheral Nerve

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Patient-Reported Outcomes After Migraine Surgery: A Novel Qualitative Approach
Jacqueline S. Israel MD, Corinne R. Esquibel PhD, Aaron M. Dingle PhD, Yuming Liu PhD, Adib Keikhosravi, Madison A. Hesse, Sarah K. Brodnick BS, Jane A. Pisaniello BS, Joseph R. Novello MS, Lisa Krugner-Higby DVM, PhD, Justin C. Williams PhD, Kevin W. Eliceiri PhD, Samuel O. Poore MD, PhD
University of Wisconsin -Madison, Madison, WI

Introduction: Outcomes after decompression of peripheral nerves contributing to migraine headaches (e.g. migraine surgery) have been previously assessed using quantitative methods, including calculation of headache frequency and medication use, as well as the use of validated headache questionnaires. Qualitative methods, while infrequently utilized in plastic surgery, offer the unique ability to probe patient perspectives and expectations. The purpose of this study is to explore, via in-depth patient interviews, patients’ experience with migraines and migraine surgery and compare the interview narratives to scores on objective questionnaires.
Materials and Methods: Patients who had previously undergone migraine surgery by a single surgeon were identified and recruited using purposive sampling. Participation was voluntary and confidential. Interviews were semi-structured, conducted by a single study team member, approximately 60 minutes in duration, and transcribed in their entirety. Subjects were asked to complete three validated headache questionnaires. A multidisciplinary team with backgrounds in surgery, pain management, and internal medicine coded transcripts using constructivist grounded theory methodology.
Results: Nine subjects have been interviewed. Seven subjects were female and the mean age was 48 +/- 15 years at time of interview. The mean time from surgery to interview was 20 +/- 8 months. Seven of nine subjects (78%) reported high satisfaction with their outcome after surgery. Themes that emerged during focused coding included: A tendency to speak favorably of surgery and life after surgery despite persistent headaches, “predictability” in migraine after surgery, differentiation between “headache” and “migraine,” “respite” from migraine, and changes in medication effectiveness following surgery. Several subjects relayed that their use of abortive and preventive medications stayed the same or increased postoperatively, but they attributed this to their medications becoming newly effective after surgery. Even subjects with moderate or high disability scores on postoperative questionnaires reported aspects of improved quality of life.
Conclusions: Qualitative data, in the form of rigorously analyzed patient interviews, offer an important addition to outcomes after peripheral nerve surgery to treat migraines. Patients experience improvements in quality of life that are not depicted by existing metrics. The use of qualitative methodologies alongside quantitative techniques adds the patient's voice, an essential component in assessing the impact of this treatment. Insight gleaned from patient interviews is important for migraine surgeons, referring physicians, and patients, and may facilitate the development of an assessment tool specific to migraine surgery.


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