Efficacy of Migraine Surgery in Reducing Pharmacological Treatment Requirements

Migraines affect 35 million Americans, leading to decreased quality of life, and are the third leading cause of disability worldwide. Recent studies have demonstrated a nearly 90% success rate for migraine surgery, defined as elimination of or at least a 50% reduction in symptoms. This study aimed to determine the effect of migraine surgery on medication use.

A national insurance database containing International Classification of Diseases and Current Procedural Terminology codes, along with patient demographics, was used. Patients diagnosed with chronic migraines using International Classification of Diseases codes were included. Propensity score matching using medical comorbidities created a treatment group that underwent peripheral nerve decompression or transection surgery (CPT-64716 or CPT-64771) and a control group that did not undergo surgery. Medication use before and after surgery was compared among surgical patients. A logistic regression was performed to identify predictors of undergoing migraine surgery.

In a database of 165 million patients, 10,641,115 (6.4%) were identified with migraines. Of these, 1852 (0.02%) underwent migraine surgery, with a mean and median time to surgery of 3.1 and 2.3 years, respectively (SD 2.8 years). Propensity score matching resulted in 1948 patients in both control and treatment groups. After surgery, the use of abortive medications, including triptans, ergots, and nonsteroidal anti-inflammatory drugs, decreased significantly ( P < 0.05). Preventative medication use, including β-blockers, antiepileptics, calcium channel blockers, and antidepressants, also decreased significantly ( P < 0.01).

Peripheral nerve decompression or transection surgery may be effective in reducing medication use among patients with migraine. Further research is needed to assess the impact of migraine surgery on overall health care costs.