According to a study in the issue of Plastic and Reconstructive Surgery®, in addition to reducing headache frequency and severity, surgical treatment for a migraine considerably improve everyday functioning and coping ability.

William Gerald Austen, an investigator said, “Our study demonstrates the high functional disability experienced by migraine patients, compared to those with other pain conditions. The results also show that migraine surgery can lead to dramatic improvements in functioning and coping ability, even in patients who are very disabled before surgery.”

For patients with chronic, severe migraine headaches, surgery has become recognized as an effective treatment option when they do not respond to standard treatments. Developed by plastic surgeons who noticed that some migraine patients had fewer headaches after cosmetic forehead-lift, migraine surgery procedures address trigger sites linked to certain headache patterns.

However, most studies evaluating migraine surgery have relied on migraine-specific questionnaires. Pain questionnaires used in the evaluation of better-understood and more common pain syndromes have not been applied to migraine surgery. The study evaluated the performance of one such questionnaire [the Pain Self Efficacy Questionnaire (PSEQ)] in migraine surgery patients.

The PSEQ has been used to study treatment outcomes in patients with a wide range of pain conditions.The PSEQ provides information on pain scores as well as on functional disability and ability to cope with pain when performing normal daily activities. The study included 90 patients who underwent migraine surgery.

Before and after surgery, patients were evaluated on a standard migraine questionnaire (the Migraine Headache Inventory, or MHI) and on the PSEQ. The final analysis included 74 patients who completed both questionnaires at one-year follow-up after migraine surgery. The patients had extremely poor PSEQ scores, indicating a high level of disability before migraine surgery.

Preoperative pain coping scores in migraine patients were substantially lower than reported for patients with other types of chronic pain. One year after migraine surgery, the patients had a very large improvement (on average, 112% higher than baseline) in PSEQ score that was significantly higher than in studies of patients with other types of chronic pain.

Migraine surgery improved functioning and coping even in patients with very low initial PSEQ scores in contrast to patients with musculoskeletal problems such as low back pain. The surgery also led to an average 76% improvement in the migraine-specific MHI score, measuring outcomes like headache frequency, duration, and severity.

The study revealed continued positive outcomes after migraine surgery in appropriately selected patients, including large improvements in migraine-related disability. Chronic pain questionnaires such as the PSEQ add to our understanding of functional outcome after surgery and put pain in migraine surgery patients in perspective to better-known pain conditions, the researchers concluded.