LONG-TERM results of migraine surgery and the relationship between anatomical variation and pain

Objective: Despite many studies in the literature on the long-term results of migraine surgery, there are not enough studies in our country that evaluate the long- term results of migraine surgery treatment with objective methods [MHI (Migraine Headache Index), MIDAS (Migraine Disability Assessment Score), VAS (Visuel Analog Scale)]. In addition, anatomical symmetry differences are observed between the right and left sides of the patients. There are not enough publications in the literature showing the relationship between these anatomical differences and pain. In this study, it was aimed to determine the long-term results of patients who underwent migraine surgery and to describe the relationship between pain and anatomical symmetry difference. Materials and Methods: Our study is a clinical study and a prospective study with a retrospective part. The study included 93 patients who were operated in the Plastic, Reconstructive and Aesthetic Surgery clinic of KTU Farabi Hospital between 2017-2021 and were followed up for at least one year after the operation, and who underwent operations from a total of 240 regions. Preoperative age, gender, duration of migraine (years), presence of half a headache, presence of visual signs (aura), preoperative monthly average attacks, preoperative monthly average attack durations (hours), preoperative monthly average attacks severity (1-10), migraine pain indices (MHI), and preoperative disability rates (MIDAS score) were recorded. Anatomical data were obtained by recording the findings during surgery. Migraine surgery was performed bilaterally in all patients. Anatomical symmetry differences between the right and left sides were recorded in the same patient. All patients included in the study were followed up for at least 12 months after surgery. At the last follow-up of the patients, the mean number of attacks per month after the operation, the average monthly attack duration (hours) after the operation, the average monthly attack severity (1-10), the migraine pain indices (MHI) and the postoperative disability rates (MIDAS score) were recorded. SPSS 23.0 statistical program was used in the statistical analysis phase. Results: 69% of the patients were female and 31% were male. The mean age of the patients who underwent migraine surgery was 40.0 ± 9.8 years. The mean follow-up time after migraine surgery was 37±10.9. The mean monthly attack duration before migraine surgery was found to be 24.0±21.6 hours. The mean monthly attack duration after migraine surgery was found to be 10.0±19.4 hours. A significant difference was found in the attack duration before and after surgery. The mean attack severity before migraine surgery was found to be 10.0±0.9. The mean severity of attacks after migraine surgery was 4.0±3.0. A significant difference was found in the severity of attacks before and after surgery. The mean MHI before migraine surgery was found to be 100.0± 93.6. The mean MHI after migraine surgery was 4.5±67.3. A significant difference was found in the migraine attack index before and after surgery (p<0.001). More than 50% reduction in migraine pain index (MHI) was found in 84.9% of the patients. Less than 50% reduction in migraine pain index (MHI) was found in 15.1% of the patients. There was a 100% reduction in 14% of patients. A significant difference was found between the number of attacks and the duration of attacks before surgery and the change in MHI. The mean MIDAS before migraine surgery was 4.0±0.7. The mean MIDAS score after migraine surgery was 1.0±1.2. Significant difference was found in the MIDAS score before and after surgery. Thirty (32.3%) of the patients had bilateral headaches and 63 (67.7%) had unilateral headaches. 51 (81%) patients with unilateral headache were anatomically asymmetrical and 12 (12%) were anatomically symmetrical. Patients with unilateral headache were found to be anatomically highly asymmetrical. A statistically significant difference was also found in the comparison of anatomical asymmetry in patients with unilateral headache. Conclusion: Previous studies have shown that surgical treatment of migraine is effective and long-term protection. Our study also shows that surgical treatment is effective and long-term protection. Migraine surgery is a cost-effective treatment with mild side effects such as alopecia and numbness at the incision sites that are easily tolerated by the patient and with dramatic improvement in quality of life. The fact that half headache and anatomical asymmetry were significant in our study supports the peripheral mechanism. Our study is the first in the literature to compare the relationship between unilateral headache and anatomical asymmetry.