Nasal Pathology in the Migraine Surgery Population: Incidence, Patterns, and Predictors of Surgical Success
Michelle Lee MD, Cameron Erickson BS, Bahman Guyuron MD
University Hospitals Case Medical Center, Case Western Reserve University
Migraine headache (MH) is a common and debilitating neurological disorder characterized with recurrent headache episodes. Its prevalence in the United States has been estimated to be 28 to 35 million with a predilection for female patients (18% female and 6% male). The incidence of MH peaks between ages 25-50, the most productive years of an individual. Treatment for MH ranges from conservative to preventive and abortive to invasive. Conservative treatments include avoidance of environmental trigger sites, and pharmacologic therapies. More invasive treatments include injection of botulinum toxin-A, nerve blocks for temporary migraine pain relief, placement of nerve stimulators, and finally surgical decompression of peripheral nerves. To date, six peripheral migraine headache trigger sites have been identified. The most common trigger site is migraine site III (septonasal), which has been identified in 66.9% of migraine surgery patients. Despite being the most frequent trigger site, there is a paucity of information on the extent of nasal pathology and its correlation with migraine surgery success in this subset of patients.
The incidence of various nasal pathology in the migraine surgery III (septonasal trigger) patient population is unknown. The purpose of this study is to identify the patterns of nasal pathology in 100 randomly selected migraine surgery III patients and identify potential correlations with migraine surgery success.
A retrospective review of a prospectively maintained database was performed. One hundred patients who underwent migraine III (septonasal trigger) by the senior author from 2007 to 2011 were included in the study. Charts were reviewed for patient demographics, pre and post migraine symptoms, prior nasal and sinus symptoms, anatomical pathology seen on preoperative computed tomography (CT) scans, and surgery outcomes.
This is the first cohort study to identify the incidence and pattern of nasal pathology in migraine III patients. There is an increased incidence of septal deviation, sinus disease, and turbinate abnormality in migraine III patients. 1, 2 Patients who fail migraine surgery have a higher incidence of preoperative contact points seen on CT scan. It is likely that the failure to achieve more successful outcome was the consequence of conservative nasal management and residual contact points due to concern for the development of nasal dryness. Successful removal of middle turbinate concha bullosa may result in better surgical outcomes.