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In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)
Mona Ascha, David Kurlander, Abdus Sattar, James Gatherwright, Bahman Guyuron
University Hospitals Case Medical Center
2017-01-25
Presenter: Mona Ascha
Affidavit:
This abstract represents original work of the authors. The written paper has been accepted to Plastic and Reconstructive Surgery Journal but has not been published. We do not expect publication of this work prior to the OVSPS meeting.
Director Name: Mona Ascha
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: This study reports the surgical technique and efficacy of deactivation of occipital-triggered migraine headaches (OMH). In addition, it reports the effect of surgical deactivation of OMH on migraine triggers and associated symptoms other than pain.
Methods: 195 patients undergoing surgery for OMH by a single surgeon, and followed at least 1 year, were analyzed. Median regression adjusted for age, gender, and follow-up time was used to determine post-operative reduction in occipital-specific Migraine Headache Index (OMHI), which is the product of migraine duration, frequency, and severity. Reduction in migraine-days was also measured. The association between symptom or trigger resolution and OMHI reduction was studied by logistic regression. Details of surgical treatment are discussed and complication rates reported.
Results: Eighty-two percent (n=160) of patients reported successful surgery at least 12 months following surgery (mean follow-up 3.67 years). Eighty-six (n=168) percent of patients had successful surgery as measured by migraine-days. Fifty-two percent reported complete OMH elimination. Symptoms resolving with successful surgery beyond headache include being bothered by light and noise, feeling lightheaded, difficulty concentrating, vomiting, blurred/double vision, diarrhea, visual aura, numbness and tingling, speech difficulty, and limb weakness (p<0.05). Triggers resolving with successful surgery include missed meals, bright sunshine, loud noise, fatigue, certain smells, stress, certain foods, coughing, straining, and bending over, letdown after stress, and weather change (p<0.05).
Conclusion: Surgical deactivation of OMH provides long-lasting migraine relief. Successful site IV surgery is associated with changes in specific symptoms and triggers. This can assist in trigger avoidance and aid OMH trigger-site identification.
