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Clinical Effectiveness of Peripheral Nerve Blocks for Diagnosis of Migraine Trigger Points
Shiva M. Rangwani, B.A.
Jason D. Hehr, MD
Jeffrey E. Janis, MD, FACS
The Ohio State University College of Medicine
2020-02-15
Presenter: Shiva M. Rangwani
Affidavit:
I certify that the work submitted has not been published in any scientific journal or previously presented at a major meeting. Further, the work submitted is fully original and compiled by the three above authors listed.
Director Name: Gregory D. Pearson, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: With a 13% global prevalence, migraine headaches (MH) are the most commonly-diagnosed neurologic disorder, and are a top five cause of visits to the emergency room. Surgical techniques-such as decompression and/or ablation of neurovasculature-have shown to provide relief in patients suffering from MH. Popular diagnostic modalities to identify trigger loci include handheld doppler exams and botulinum toxin injection. This paper aims to establish the positive predictive value (PPV) of peripheral nerve blocks for identifying therapeutic surgical targets for MH surgery.
Methods: Charts of 36 patients were retrospectively analyzed. These patients underwent peripheral nerve blocks using 1% lidocaine with epinephrine and subsequent surgery on identified MH trigger points. Patients were grouped into successful and unsuccessful blocks and further categorized into successful and unsuccessful surgery subgroups. Group analysis was done using paired t-tests and PPV calculations were done on subgroups.
Results: Mean post-surgical follow up was 11.5 months. Prior to surgery, Migraine Headache Index (MHI) of patients was 168.16 vs. 43.69 after surgery (p<0.001). Each of the components of MHI also significantly decreased: frequency (24.54 MH/month vs. 8.53, p<0.001), intensity (7.33 vs. 4.75, p<0.001), and duration (0.8 days vs. 0.39, p<0.001). The PPV of diagnostic peripheral nerve blocks in identifying a MH trigger point responsive to surgical intervention was calculated to be 0.89 (95% CI: 1, 0.74).
Conclusion: Peripheral nerve blocks serve as a clinical tool in mapping migraine trigger points for surgical intervention while offering more flexibility in their administration and recording as compared to established diagnostic methods.
