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Psychiatric Conditions In Patients Undergoing Trigger Site Deactivation Surgery For Nerve Compression Headaches
Ricardo Ortiz, BSc, Lisa Gfrerer, MD PhD, Marek A. Hansdorfer, MD, Jane Tsui, MD, Kassandra P. Nealon, BSc, William G. Austen, Jr., MD.
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

PURPOSE:
Patients seeking surgery for their nerve compression headaches often have debilitating symptoms that can affect both their functional and psychological well-being. Prior studies have shown strong associations between psychiatric conditions and migraine headaches. This correlation has not been investigated in patients undergoing surgery for headaches.
METHODS:
One-hundred and twenty-nine patients were enrolled prospectively and completed the Patient Health Questionnaire-2 (PHQ-2) and Migraine Headache Index (MHI) surveys preoperatively and at twelve months postoperatively. Data on psychiatric comorbidities were collected both via survey and via retrospective chart review.
RESULTS:
Preoperatively, 38% of patients self-reported a diagnosis of depression, while 45% of patients met PHQ-2 criteria for likely major depressive disorder (PHQ-2 score of three or greater). Twenty-seven percent of patients reported a diagnosis of generalized anxiety disorder. Patients with self-reported depression and anxiety were more likely to report a higher severity of migraine symptoms (P<0.01 and P=0.025, respectively). At one year postoperatively, patients reported a significant decrease in their PHQ-2 score (P=0.02), with 22% of patients reporting depressive symptoms, as compared to 45% preoperatively. The preoperative presence of anxiety or depression did not affect postoperative outcomes.
CONCLUSION:
There is a high prevalence of depression and generalized anxiety disorder in patients undergoing surgery for nerve compression headaches. Comorbid psychiatric conditions do not appear to affect postsurgical outcomes. However, surgery is associated with a significant decrease in depressive symptoms. Prior studies have shown that the surgical treatment of migraine headaches is associated with improved headache symptoms and functionality. This study demonstrates that surgery is also associated with improved mental health.


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