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Surgical Treatment of Refractory Migraine Headaches: Preoperative Utility Assessment and Post-Operative Symptomatic Evaluation
Radbeh Torabi, MD1; Jacob P Veith, BS11; Lynn A Bourn, BS1; Ahmed Ibrahim, MD, PhD1; Matthew J Bartow, MD1; William G Austen Jr., MD2; Tessler Oren, MD1
1Louisiana State University Health Sciences Center, New Orleans, LA, 2Massachusetts General Hospital, Boston, MA
Background: Surgical treatment for migraine headaches, refractory to medical treatment, has recently produced promising results for patients with limited options. Utility scores are standardized tools offering validated means of measuring the health state preference of a health condition or disease state. The aim of this study was to prospectively determine the impact of the health state burden, prior to surgical treatment, to characterize the quality of life for this patient population and the symptomatic outcome post-operatively.
Methods: 28 consecutive patients [2 male (7.1%), 26 females (92.9%)], age of 48.1 years (SD=14.7) undergoing surgery for migraines were prospectively assessed to establish utility scores [visual analogue scale (VAS), time-trade off (TTO), and standard gamble (SG)] and Migraine-Specific Symptoms and Disability (MSSD) prior to surgical treatment. 15 patients reached 3 months follow up and completed MSSD.
Results: Despite medical treatment, MSSD demonstrated mean 17.3 headaches per month (SD=9.7), lasting 9.5 hours (SD=9.4) per episode, with a mean pain score of 7.6 (SD=1.6) for patients prior to surgical treatment. Utility scores (VAS, TTO, SG) for migraine headaches were 0.54 (SD=0.25), 0.57 (SD=0.25), and 0.62 (SD=0.27) respectively; similar to those for monocular blindness (0.49, 0.64, 0.61) but higher than binocular blindness (0.26, 0.32, 0.27), pre operatively. MSSD completed at 3 months demonstrated an overall improvement with mean 5.9 headaches per month (SD=6.2), lasting 5.3 hours (SD=7.9) with a mean pain score of 5.6 (SD=3.6). Of the 15 patients evaluated at 3 months, 9 patients demonstrated a symptomatic improvement >75% when multiplying number of headaches per month, length of headaches and pain score, including 5 patients with complete resolution of symptoms. Evaluation of the number of trigger points of the 6 patients that did not respond, demonstrated a mean of 3.6 trigger points pre-operatively (SD=1.1) and 2.6 trigger points post-operatively (SD=1.1).
Conclusion: Migraine headaches refractory to medical treatment can be objectively assessed using utility scores. Utility scores for migraine headaches were comparable to previously published data for unilateral facial paralysis and lower extremity lymphedema, and worse in comparison to common cosmetic deformities such as breast ptosis and an aging neck. Symptomatic evaluation at 3 months post-operatively showed the majority of the patients (n=9) undergoing surgery improved, while the non-responders (n=6) had a decreased number of trigger points. We have described the health state burden, in a prospective manner, in order to expand the benefits of surgical treatment of refractory migraine headaches.
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