Comparing Migraine Headache Index versus Monthly Migraine Days after Headache Surgery: A Systematic Review and Meta-Analysis

Background:Nerve deactivation surgery for the treatment of migraine has evolved rapidly over the past 2 decades. Studies typically report changes in migraine frequency (attacks/month), attack duration, attack intensity, and their composite score-the Migraine Headache Index-as primary outcomes. However, the neurology literature predominantly reports migraine prophylaxis outcomes as change in monthly migraine days (MMD). The goal of this study was to foster common communication between plastic surgeons and neurologists by assessing the effect of nerve deactivation surgery on MMD and motivating future studies to include MMD in their reported outcomes.Methods:An updated literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Library of Medicine (PubMed), Scopus, and Embase were systematically searched for relevant articles. Data were extracted and analyzed from studies that met the inclusion criteria.Results:A total of 19 studies were included. There was a significant overall reduction in MMDs [mean difference (MD), 14.11; 95% CI, 10.95 to 17.27; I2 = 92%], total migraine attacks per month (MD, 8.65; 95% CI, 7.84 to 9.46; I2 = 90%), Migraine Headache Index (MD, 76.59; 95% CI, 60.85 to 92.32; I2 = 98%), migraine attack intensity (MD, 3.84; 95% CI, 3.35 to 4.33; I2 = 98%), and migraine attack duration (MD, 11.80; 95% CI, 6.44 to 17.16; I2 = 99%) at follow-up (range, 6 to 38 months).Conclusion:This study demonstrates the efficacy of nerve deactivation surgery on the outcomes used in both the plastic and reconstructive surgery and neurology literature.