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"Like a Normal Person Again": A Qualitative Analysis of the Impact of Headache Surgery
Ahmed M Afifi1, Margaret L Schwarze1, Emmaline K Stilp1
1From the Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health; the Departments of Surgery, Medicine, and Anesthesiology, University of Wisconsin School of Medicine and Public Health; the Division of Plastic Surgery, Cairo University; Qualitative Health Research Consultants; the Department of Sociology, Drexel University; and Edgewood College of Nursing.
Background:
Outcomes after migraine surgery have been previously assessed using quantitative measurements, including the migraine headache index. Qualitative methodologies offer the ability to analyze patients' perceptions and pain experience, and may point to changes in domains not captured by quantitative instruments. The purpose of this study was to characterize individual patients' experiences with migraines and to analyze how patients' experience of headaches changes in relation to surgery.
Methods:
Patients who previously underwent migraine surgery performed by a single surgeon participated in semistructured interviews at least 1 year after surgery. Purposive sampling was used to recruit patients [n = 15 (73 percent female)]. Interviews were transcribed verbatim. A multidisciplinary team with backgrounds in surgery, pain management, medicine, and health services research coded and analyzed transcripts.
Results:
Participants reported improvements in one or more domains of pain following surgery, and changes in medication use and effectiveness. Even in individuals with persistent pain postoperatively, surgery appeared to facilitate an improvement in headache self-efficacy, including an ability to participate in daily activities. Migraineurs frequently described a new degree of control over at least one aspect of their pain.
Conclusions:
Migraine surgery appears to positively impact patients' lives in ways that support and expand on previously published outcomes. Patients report benefiting from surgery in ways that are not currently captured in commonly used metrics. This study's findings support the need for more specific patient-reported outcome measures to help clinicians and patients understand the impact of surgery and which outcomes matter most to patients.
