title: Is Migraine Surgery Ready for Prime Time? The Surgical Team's View.
abstract: BACKGROUND
  Based on unsolicited reports by patients that their headaches had ceased or reduced following forehead rejuvenation, our team began stepwise and logical studies to investigate the efficacy of surgery as a potential preventive modality for selected patients with migraine headaches (MH). The purpose of this report is to summarize the pertinent studies demonstrating the efficacy of surgical decompression trigger sites of migraine trigger sites.
  
  
  METHODS
  These studies included a retrospective, a prospective pilot, a prospective randomized study with a control arm, a prospective randomized study with sham surgery, and a 5-year follow-up. There were 3 reputable and respected neurologists who specialize in headaches, an expert biostatistician, 13 residents, and 10 medical students involved in these studies.
  
  
  RESULTS
  In our retrospective study, of the 249 patients, 39 confirmed having MH prior to the surgery, and 31 (P < .0001) experienced either complete elimination or significant improvement (at least 50% reduction) of their MH. In our prospective pilot study, 21 of the 22 patients noted a significant improvement (P < .001). In our prospective randomized study, 82 of 89 (92%) observed at least 50% improvement in the frequency, intensity, and duration of MH (P < .00001). Sixty-one of 69 (88%) patients in this study who were followed for 5 years persisted to have significant improvement after 5 years (P < .0001). In our randomized study involving sham surgery, 21 of the 49 (83%) patients benefitted from the real surgery compared to 15 of 26 (56%) patients in the sham surgery group (P = .014). While 28 (57%) patients in the real surgery group observed complete elimination, only 1 patient in the sham surgery group reported elimination (P < .0001).
  
  
  CONCLUSIONS
  This report discusses the facts surrounding the discovery of this surgery, demonstrates accuracy of our studies and effectiveness of the proposed surgeries and dispels some of the unfounded assertions trying to discredit the research that we have conducted over 14 years.
authors.affiliation: Emeritus Professor of Plastic Surgery, Case School of Medicine, Cleveland, OH, USA.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000601:surgery*; D000069471:Neurosurgeons / Q000639:trends; D019635:Neurosurgical Procedures / Q000639:trends; D010865:Pilot Projects; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors
keywords: migraine; migraine surgery; trigger