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A Comparison of Outcome of Surgical Treatment of Migraine Headaches using Constellation of Symptoms Versus Botulinum Toxin A to Identify the Trigger Sites

Mengyuan T Liu, Bryan S Armijo, Bahman Guyuron
Case Western Reserve School of Medicine/Case Medical Center
2012-01-19

Presenter: Mengyuan T Liu

Affidavit:
The above work represented 85% of the student's original work.

Director Name: Bahman Guyuron, MD, FACS

Author Category: Student
Presentation Category: Clinical
Abstract Category: General Reconstruction

How does this presentation meet the established conference educational objectives?
This presentation addresses a new, more efficient, less invasive diagnostic technique for patients undergoing surgical interventions for migraine headaches.

How will your presentation be used by practicing physicians in the audience?
Currently, the accepted protocol for diagnosing migraine headache trigger sites is performing single-site step-wise Botulinum toxin A injections at 1-month intervals. This protocol takes up to 3 months to perform, which significantly prolongs the patient's treatment course. This presentation will show participating physicians that diagnosing migraine headache trigger sites using only constellation of symptoms is just as effective as using step-wise BTA injections, thus decreasing patients' treatment course by up to 3 months.

Background:
This study was designed to assess whether pre-surgery trigger site confirmation using botulinum toxin A (BTA) injections significantly improved migraine surgery outcomes.

Methods:
The medical charts of 335 migraine surgery patients were reviewed. Patients who received step-wise diagnostic BTA injections were placed in the BTA group (n=245). Patients who did not receive BTA or only received therapeutic BTA were placed in the control group (n=90). The preoperative and 12-month postoperative migraine headache frequency, duration, and intensity were compared to determine the success of the surgeries.

Results:
Seventy-two (80%) of 90 control patients experienced a significant improvement (at least a 50% decrease in migraine headache frequency, duration, or intensity) at 12 months after surgery, with 29 (32%) reporting complete elimination. Of the 245 BTA patients, 207 (84%) experienced a significant improvement, with 89 (36%) experiencing complete elimination. The surgical success rate of the BTA group was not significantly higher than that of the control group (p=0.33).

Conclusions:
Confirmation of trigger sites using BTA does not significantly improve the outcome of migraine surgery. Although BTA can be a useful diagnostic tool, this study demonstrates that there is no statically significant difference between the injection of BTA and the use of constellation of symptoms to identify trigger sites.

Author Contact Information:
Mengyuan Liu
2800 Mayfield Rd, Unit A
Cleveland Heights, OH
44118

6507143905
650-714-3905 (cell)

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