Surgical Management of Migraine Headaches: A Systematic Review and Meta-analysis
Background: The aim of the present study was to systematically review and analyze the available evidence on the role of surgery in improving outcomes in patients with migraine headaches.
Methods: An electronic search of PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases was performed for English-language articles reporting results of peripheral nerve surgery for migraine headaches.
Results: The search strategy revealed a total of 1528 records, of which 23 studies were included in the review. A total of 1151 headache patients were treated in the included studies. The trigger site of migraine addressed varied across studies. Meta-analysis of data of 616 patients revealed that migraine surgery significantly reduces migraine headache frequency (random: mean, 9.52; 95% confidence interval, 7.14–11.9; P < 0.00001; I2 = 94%). Similarly, when data of 797 patients were analyzed, there was statistically significant reduction in migraine headache intensity in patients undergoing migraine headache surgery (random: mean, 3.97; 95% confidence interval, 3.31–4.62; P < 0.00001; I2 = 94%). On pooling of data of all 23 studies, 8.3% to 76.4% of patients reported complete elimination of headache after surgery, whereas 3.9% to 33.3% had no relief.
Conclusions: Peripheral nerve decompression surgery is highly effective in reducing migraine headache frequency and migraine headache intensity. However, not all patients benefit from the surgical procedure, with a small subset showing no improvement. Further clinical and anatomical studies are needed to define the exact mechanism of nerve compression in migraine patients and as to why a subset of patients does not respond to surgical treatment.