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The Role of Triamcinolone Injection In Outcome Of Occipital Nerve Decompression For Surgical Treatment of Migraine Headaches
Mikhal A. Monson, Michelle Lee, MD, Tommy Liu, Bahman Guyuron, MD
Case Western Reserve University School of Medicine
2012-02-05
Presenter: Andrea Monson
Affidavit:
The submitted project abstract is entirely original work of the student and resident authors. The final ideas and results of this study are based off of known procedures with the addition of other known medical practices to reach a final new conclusion.
Director Name: Bahman Guyuron, MD
Author Category: Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
The statistical analysis preformed for this project comes from over 400 patients who suffer from migraine headaches and receive surgical treatment for these headaches with craniomaxillofacial nerve decompression surgery. The new techniques implemented with this surgery have proved to improve patient outcomes by reducing migraine headache frequency.
How will your presentation be used by practicing physicians in the audience?
With the information provided practicing physicians may incorporate new steps to already established practices to obtain a better treatment outcome for their patients suffering from migraine headaches.
Studies have demonstrated the efficacy of greater occipital nerve (GON) surgical decompression in treatment of migraine headaches (MH). Objective: determine whether triamcinolone injection into the GON and surrounding tissues affects GON decompression as surgical treatment of MH (site IV).
A comparative retrospective chart review was performed on patients undergoing GON decompression for surgical treatment of occiptal MH by the senior author from January 2000 - December 2010. Inclusion criteria: 1) completed migraine pre and post surgical questionnaire, 2) Site IV decompression, 3) at least one year follow-up. Patients were divided into two cohorts: received GON triamcinolone injection (Kenalog Group) and no injection (No Kenalog Group). Outcome variable is MH index reduction. Statistical analysis included descriptive statistics and student's t-test. The migraine index (MI) is defined as migraine severity multiplied by migraine frequency multiplied by migraine duration.
476 patients met the inclusion criteria: 282 in the Kenalog Group, 194 in the No Kenalog Group. Mean follow up was 519 days. Groups were well matched in demographics such as age and gender. Kenalog Group had a greater reduction in MI (post surgery MI- pre-surgery MI). Average MI reduction in the Kenalog Group was -92.91 versus -65.18 in the No Kenalog Group (p=0.006). Kenalog Group had statistically significant reduction in migraine frequency (-9.8 versus -8.0, p = 0.03). There is no difference between the two groups in severity or duration reduction.
Triamcinolone injection into the GON and surrounding structures during GON decompression for surgical treatment of MHs improves surgical outcome through additional reduction of MH frequency.
