American Society for Peripheral Nerve

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The Surgical Treatment of Chronic Headaches: Lessons Learned From the First 100 Cases
Ziv Peled, MD
Peled Plastic Surgery, San Francisco, CA

Introduction: The surgical treatment of chronic headaches has been well established in the plastic surgical literature as a viable and successful method of addressing a very common and difficult clinical problem. This treatment modality is not only very effective, but especially useful in those cases refractory to medical management.

Methods and Results: Prospectively collected data on my first 100 surgical headache cases were analyzed. Migraine Headache Index, an established and reliable gauge of headache severity was used to measure outcomes. A successful result was defined as at least a 50% reduction in the frequency, duration, and/or severity of headache symptoms in keeping with results reported in previously published literature. Cases included frontal, temporal, and occipital procedures.

87% of patients experienced at least a 50% reduction in the frequency, duration, and/or severity of their headache symptoms. 40% experienced complete elimination of their severe headaches. Migraine Headache Index scores were also significantly improved post-operatively (143 vs 35, P<0.0001). Mean follow-up was 16.6 months.

Conclusions: Successful outcomes can be achieved with surgical treatment of chronic, severe headaches, but it is important to note that incorporating this modality into one’s practice can be challenging. There can be significant resistance in the medical community to this relatively novel treatment modality and the patients themselves can be demanding, much like any chronic pain population. Several practical suggestions as to how to deal with these barriers and challenges are proposed.

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