title: Impact of preoperative narcotic use on outcomes in migraine surgery.
abstract: BACKGROUND
  This study focuses on the impact of preoperative narcotic medication use on outcomes of surgical treatment of migraine headaches.
  
  
  METHODS
  A retrospective comparative review was conducted with patients undergoing migraine surgery. Data gathered included demographic information, baseline migraine headache characteristics, migraine surgery sites, postoperative migraine headache characteristics 1 year or more following surgery, and preoperative migraine medication use. Patients were grouped based on preoperative narcotic medication use. The narcotic users were subdivided into low and high narcotic user groups. Preoperative migraine characteristics were comparable between groups and the outcomes of migraine surgery were compared between the groups.
  
  
  RESULTS
  Outcomes in 90 narcotic users were compared with those for 112 patients not using narcotic medications preoperatively. Narcotic users showed statistically significantly less reduction in frequency, severity, and duration of migraine headaches after surgery. Narcotic users had clinical improvement in 66.7 percent of patients and elimination in 18.9 percent versus 86.6 and 36.6 percent, respectively, in the nonnarcotic group. The group that consumed narcotics had significantly lower rates of improvement in all migraine indices.
  
  
  CONCLUSIONS
  Previous studies have discouraged the routine use of narcotic medications in the management of migraine medications. The authors' study demonstrates that narcotic medication use before migraine headache surgery may predispose patients to worse outcomes postoperatively. Because pain cannot be objectively documented, the question remains of whether this failure to improve the pain was indeed a suboptimal response to surgery or the need for narcotic substances.
  
  
  METHODS
  Risk, II.
authors.affiliation: Cleveland, Ohio From the Department of Plastic Surgery, Case Western Reserve University, and the American Migraine Center.
authors.forename: Paul
authors.initials: P
authors.lastname: Adenuga
authors.forename: Matthew
authors.initials: M
authors.lastname: Brown
authors.forename: Deborah
authors.initials: D
authors.lastname: Reed
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000601:surgery*; D009294:Narcotics / Q000627:therapeutic use*; D057234:Preoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009294:Narcotics