Auriculotemporal Nerve-Triggered Migraine Improved With Surgery

Investigators found that bilateral surgery showed the greatest improvement with more migraine-free days postsurgery.

Surgery for auriculotemporal nerve–triggered migraine headaches results in improvement in all migraine parameters (intensity, duration, migraine-free days), regardless of laterality of the procedure, according to a study published in Plastic and Reconstructive Surgery.

Patients who underwent surgery for migraine headaches triggered by the auriculotemporal nerve, also known as site V, (N=43) were included in this study; the majority thereof underwent bilateral surgery (n=36). Migraine frequency, duration, severity, and anatomical location of pain were assessed before surgery with global migraine headache questionnaires. Patients were contacted post-operatively to provide updated migraine data. The average follow-up time was 17.2 months.

The number of migraine-free days (per month) significantly increased from 12.57 days pre-surgery to 25.12 days post-surgery (median change, 12.55; 95% confidence interval [CI], 8.7-17.5; P <.005). Median scores of migraine intensity significantly decreased from 8.31 to 3.22 on a 10-point severity scale days post-surgery (median decrease, 5.09; 95% CI, 4.5-7.0; P <.005). Migraine duration decreased from 1.22 hours/day to 0.5 hour/day after surgery (median decrease, 0.71 hour/day; 95% CI, 0.17-0.87; P <.005). Statistical significance was defined as P <.005; therefore, the median difference in migraine duration was not found to be statistically significant. Patient-reported site relief was significantly associated with decreased migraine intensity on both univariate and multivariate analyses. Furthermore, when compared to unilateral procedures, bilateral procedures showed a larger increase in migraine-free days per month, but there was no significant association between laterality and migraine duration, migraine-free days, and intensity.

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This study is limited by potential insufficiency in statistical power given its small sample size. The low P value cutoff for statistical significance is an attempt to address this shortcoming.

The findings of this study reaffirm that migraine site V surgery, which has a 79% success rate in migraine site V with minimal risk, demonstrates significant improvement in site-specific relief and overall improvement of migraine headache parameters. The authors recommend that patients seeking surgical release of this site be made aware of the positive outcomes and limitations of this procedure.

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Long T, Ascha M, Guyuron B. Efficacy of surgical treatment of migraine headaches involving the auriculotemporal nerve (site V). Plast Reconstr Surg. 2019;143(2):557-563.

This article originally appeared on Neurology Advisor