Predictors Of Surgical Success And Failure In Migraine Surgery
Lisa Gfrerer, MD PhD1, Heather R. Faulkner, MD MPH2, William G. Austen, Jr., MD2.
1Harvard Medical School, Boston, MA, USA, 2Massachusetts General Hospital, Boston, MA, USA.
Migraine surgery improves symptoms in 68-95% of patients. However, predictors of surgical success and failure remain unknown.
40 subjects were prospectively enrolled and completed questionnaires on migraine history, migraine headache index (MHI) [migraine headache (MHA) frequency x duration x pain severity], migraine disability (MIDAS), headache impact (HIT6) and pain self efficacy (PSEQ). After completing a 12-month follow- up, the ‘best’ outcome patients (MHI 0 - no migraines, n=11) and ‘worst’ outcome patients (MHI >100, n=4) were grouped and analyzed.
Age of migraine headache (MHA) onset was significantly higher in patients who failed surgery (37 versus 18.8 years); age at surgery was not significant. MHA duration was higher in non-responders (50 versus 17.8 hours), whereas pain severity and frequency were not. Factors signifying MHA severity (MHI total score, MIDAS, HIT6 and PSEQ scores) were not predictors of failure/ success.
When comparing patients with the best and worst outcomes after migraine surgery, increasing age at MHA onset and longer MHA duration are negative predictors. These factors should be considered when screening patients for surgery.
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