title: Intraoperative corticosteroid injections in migraine surgery: efficacy in preventing refractory symptoms.
abstract: BACKGROUND
  A subset of patients have been noted to have refractory migraine symptoms in site IV (occipital triggers) following primary surgery. It was postulated that the cause of refractory migraine symptoms is new scar tissue formation causing irritation of the greater occipital nerve. The goal of this study was to determine whether intraoperative corticosteroid injections have the potential to prevent these refractory symptoms.
  
  
  METHODS
  A retrospective review of all patients operated on by the senior author (B.G.) from 2000 to 2010 was undertaken. All patients who had site IV decompression and at least 1 year of follow-up were included. Patients were divided into two groups, those who had corticosteroids injected and those who did not. Data analyzed included demographics and preoperative and postoperative migraine headache symptoms review based on the migraine headache questionnaire.
  
  
  RESULTS
  A total of 476 patients were included in the study. There were 282 patients in the corticosteroid group and 194 in the no-corticosteroid group. A significant reduction was found in the frequency of migraine headaches (-9.8 versus -8.0; p = 0.03) and the migraine headache index (-92.9 versus -65.2; p = 0.0065). There was no significant reduction in migraine headache duration (-0.50 versus -0.70; p = 0.10) or severity (-3.50 versus -3.80; p = 0.38).
  
  
  CONCLUSIONS
  Intraoperative injection of corticosteroids during site IV migraine surgery may reduce migraine frequency and migraine headache index postoperatively. Corticosteroid injection in migraine site IV surgery is an effective adjunctive measure in reducing the migraine headache index.
  
  
  METHODS
  Therapeutic, III.
authors: Cleveland, Ohio From the Department of Plastic Surgery, University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; and the Department of Plastic Surgery, Case Western Reserve University.
authors: Kyle
authors: K
authors: Lineberry
authors: Michelle
authors: M
authors: Lee
authors: Andrea
authors: A
authors: Monson
authors: Bahman
authors: B
authors: Guyuron
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D019299:Decompression, Surgical / Q000009:adverse effects*; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013127:Spinal Nerves / Q000503:physiopathology*; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide
references: Guyuron B, Kriegler JS, Davis J, Amini SB. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg. 2005;115:1–9
references: Janis JE, Hatef DA, Ducic I, et al. The anatomy of the greater occipital nerve: Part II. Compression point topography. Plast Reconstr Surg. 2010;126:1563–1572
references: Li F, Ma Y, Zou J, et al. Micro-surgical decompression for greater occipital neuralgia. Turk Neurosurg. 2012;22:427–429
references: Cornely C, Fischer M, Ingianni G, Isenmann S. Greater occipital nerve neuralgia caused by pathological arterial contact: Treatment by surgical decompression. Headache. 2011;51:609–612