title: Emergence of Secondary Trigger Sites after Primary Migraine Surgery.
abstract: BACKGROUND
  Surgical decompression of a migraine headache may unmask headaches originating from secondary sites. A retrospective chart review investigated the incidence and characteristics of secondary trigger sites to identify clinical patterns that could aid in predicting and perhaps reducing postoperative migraines.
  
  
  METHODS
  One hundred eighty-five charts for migraine patients who underwent surgery at the senior author's (B.G.) practice were reviewed. Sites from which migraine headaches initiated or occurred independently were considered primary. The sites that were not active at the time of preoperative evaluation but became active after surgery were considered secondary. Bivariate analysis was performed to characterize postoperative migraines.
  
  
  RESULTS
  Of 185 patients, 33 (17.8 percent) developed secondary migraine headache trigger sites. Of patients with primary site I (frontal) symptoms, 20.83 percent had site III (septonasal) symptoms unmasked after surgery (versus 7 percent for patients with other primary sites; p = 0.04). Of the patients with site II (temporal) migraines, 17.14 percent had secondary frontal symptoms (versus 5.68 percent; p = 0.04). Primary site II symptoms predicted postoperative site IV (occipital) symptoms (11.43 versus 1.1 percent; p = 0.008), and primary occipital symptoms predicted postoperative temporal symptoms (11.1 versus 2.33 percent; p = 0.04).
  
  
  CONCLUSIONS
  The authors observed that 17.8 percent of patients develop postoperative migraine headache triggers that are not reported during the initial assessment. Knowledge of secondary migraine emergence patterns, and the presence of some preoperative symptoms, can aid in predicting the migraines that will arise from a new site postoperatively.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Case Western Reserve University.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Punjabi
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Case Western Reserve University.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brown
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Case Western Reserve University.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D003430:Cross-Sectional Studies; D019299:Decompression, Surgical; D006801:Humans; D008881:Migraine Disorders / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome