title: Clinical outcomes following supraorbital foraminotomy for treatment of frontal migraine headache.
abstract: BACKGROUND
  Although 92 percent of patients who undergo surgical decompression of the supraorbital nerve for treatment of frontal migraine headaches through resection of the glabellar muscle group achieve at least 50 percent improvement, only two-thirds demonstrate complete resolution of symptoms. The authors investigated the role of additional decompression methods by comparing surgery outcomes between patients who underwent glabellar myectomy alone and patients who also underwent supraorbital foraminotomy.
  
  
  METHODS
  Outcome measures including migraine headache frequency, severity, and duration; Migraine Headache Index score; and forehead pain were reviewed retrospectively and analyzed statistically for 43 age-matched control patients who underwent glabellar myectomy for release of the supraorbital nerve and 43 patients who underwent glabellar myectomy with supraorbital foraminotomy from 2002 to 2010.
  
  
  RESULTS
  The myectomy group statistically matched the myectomy with foraminotomy group for age, number of surgical sites, and preoperative headache characteristics (p > 0.05). For the myectomy and myectomy with foraminotomy groups, postoperative migraine frequency was 7.8 per month versus 4.1 per month, severity was 5.6 versus 4.4, Migraine Headache Index score was 26.5 versus 11.1, and persistent forehead pain was 48.8 percent versus 25.6 percent, respectively. These differences were all statistically significant (p < 0.05). Duration of headache was unchanged (p = 0.17).
  
  
  CONCLUSIONS
  The supraorbital foramen is a potential site of supraorbital nerve compression that can trigger frontal migraine headache. If it is present, the authors strongly recommend foraminotomy to ensure complete release of the supraorbital nerve to optimize outcomes. Their results also support consideration of release of any fibrous bands across the supraorbital notch.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Cleveland, Ohio From the Department of Plastic and Reconstructive Surgery, University Hospitals-Case Medical Center, and Case Western Reserve University School of Medicine.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Chepla
authors.forename: Eugene
authors.initials: E
authors.lastname: Oh
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000328:Adult; D019299:Decompression, Surgical; D005152:Facial Muscles / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000601:surgery*; D009431:Neural Conduction; D009915:Orbit / Q000294:innervation / Q000601:surgery*; D061028:Trigger Points