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Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review
Stephen A Stearns1, Helen Xun2, Anthony Haddad2
1From Harvard Medical School.
Plastic and Reconstructive Surgery
|June 20, 2023
Summary
Migraine treatments like triptans are risky for microsurgery patients due to vasoconstriction. Novel therapies and non-pharmacological options like magnesium show promise for safer postoperative migraine management.
Area of Science:
- Neurosurgery
- Pharmacology
- Vascular Medicine
Background:
- Migraine treatment options are expanding, but microsurgery patients require careful selection to maintain vascular integrity.
- This is the first scoping review examining vascular and bleeding risks of migraine therapies for microsurgical patients.
Purpose of the Study:
- To identify safe migraine therapeutics for postoperative management in reconstructive microsurgery patients.
- To evaluate the vascular and bleeding risks associated with current migraine treatments.
Main Methods:
- Compiled migraine therapeutics from UpToDate and AAFP resources.
- Conducted a PubMed literature review on each therapeutic's vascular/bleeding effects.
- Expert microsurgeons reviewed data for clinical recommendations.
Main Results:
- Triptans and ergot derivatives are contraindicated post-microsurgery due to vasoconstriction.
- Lasmiditan and CGRP antagonists are investigational abortive options with no reported vascular risks.
- Acetaminophen is the safest for symptom control; NSAIDs require further research. Botulinum toxin, magnesium, and CoQ10 are potential prophylactic options.
Conclusions:
- Microsurgery patients have limited therapeutic choices for migraines.
- This review offers preliminary guidance for prescribing postoperative migraine treatments, prioritizing vascular safety.
