Surgical Management of Migraine Headaches A Systematic Review and Meta-analysis

Background The aim of the present study was to systematically review and analyze the available evidence on the role of surgery in improving outcomes in patients with migraine headaches. Methods An electronic search of PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases was performed for English-language articles reporting results of peripheral nerve surgery for migraine headaches. Results The search strategy revealed a total of 1528 records, of which 23 studies were included in the review. A total of 1151 headache patients were treated in the included studies. The trigger site of migraine addressed varied across studies. Meta-analysis of data of 616 patients revealed that migraine surgery significantly reduces migraine headache frequency (random: mean, 9.52; 95% confidence interval, 7.14-11.9; P < 0.00001; I-2 = 94%). Similarly, when data of 797 patients were analyzed, there was statistically significant reduction in migraine headache intensity in patients undergoing migraine headache surgery (random: mean, 3.97; 95% confidence interval, 3.31-4.62; P < 0.00001; I-2 = 94%). On pooling of data of all 23 studies, 8.3% to 76.4% of patients reported complete elimination of headache after surgery, whereas 3.9% to 33.3% had no relief. Conclusions Peripheral nerve decompression surgery is highly effective in reducing migraine headache frequency and migraine headache intensity. However, not all patients benefit from the surgical procedure, with a small subset showing no improvement. Further clinical and anatomical studies are needed to define the exact mechanism of nerve compression in migraine patients and as to why a subset of patients does not respond to surgical treatment.