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Emergence of Secondary Migraine Trigger Sites After Primary Surgical Decompression
Ayesha Punjabi, Matthew Brown, and Bahman Guyuron
Case Western Reserve University School of Medicine; University Hospitals Department of Plastic and R
2014-03-13
Presenter: Ayesha Punjabi
Affidavit:
The abstract is an original work.
Director Name: Bahman Guyuron
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background/Objective: Surgical decompression of a primary migraine trigger may unmask headaches originating from secondary sites. A retrospective chart review characterized these secondary trigger sites to identify clinical patterns that could aid serving these patients more effectively.
Methods: 185 charts for migraine patients who received primary surgeries at the senior author's practice were reviewed. Sites from which migraine headaches initiated, or were most painful, were considered primary. The sites that were not active at the time of the primary evaluation but after the initial surgery were considered secondary. Bivariate analysis was performed to characterize migraine sites that become newly symptomatic postoperatively.
Results: Of patients with primary site I (frontal) symptoms, 20.83% had site III (septonasal) symptoms unmasked post-surgery (vs. 7%, p=0.04). Of the patients with primary site II (temporal), 17.14% had secondary site I symptoms (versus 5.68%, p=0.04). Patients with primary site II symptoms had greater rates of new post-operative site IV (occipital) symptoms (11.43 v. 1.1%, p=0.008), and primary site IV symptoms predicted new postoperative site II symptoms (11.1 versus 2.33%, p=0.04).
Conclusions: Decompressing primary dominant trigger sites can unmask new migraine triggers. This relationship exists for sites I and II, I and III, and II and IV. Knowledge of this pattern can aid predicting the migraines that will arise from a new site post-operatively, which in turn assists in counseling patients undergoing deactivation of a primary site.
