title: In-Depth Review of Symptoms, Triggers, and Surgical Deactivation of Frontal Migraine Headaches (Site I).
abstract: BACKGROUND
  This study reports details of the technique and assesses efficacy of surgical deactivation of frontal migraine headaches. In addition, this study examines the effect of surgical deactivation of frontal migraine headaches on migraine triggers and associated symptoms besides the pain.
  
  
  METHODS
  Charts of 270 patients undergoing surgery performed by a single surgeon for frontal migraine headaches, who were followed for at least 1 year, were analyzed. Median regression adjusted for age, sex, and follow-up time was used to determine postoperative reduction in frontal-specific Migraine Headache Index, which is the product of duration, frequency, and severity. Reduction in migraine-days, which is the product of duration and frequency, was also measured. The association between individual symptom or trigger resolution and frontal-specific Migraine Headache Index reduction was studied by logistic regression. Details of the surgical treatment are discussed and complication rates are reported.
  
  
  RESULTS
  Eighty-six percent of patients reported a successful operation (≥50 percent improvement of frontal-specific Migraine Headache Index) at least 12 months after surgery (mean follow-up, 3 years). Eighty-four percent of patients had a successful operation as measured by migraine-days. Fifty-seven percent of patients reported complete elimination of frontal migraine headaches. Symptoms resolving with successful site I surgery beyond the headaches include visual aura and blurred or double vision (p < 0.05). Triggers resolving with successful site I surgery include fatigue, weather change, and missed meals (p < 0.05).
  
  
  CONCLUSIONS
  Surgical deactivation of frontal migraine headaches provides long-lasting migraine relief. Successful site I surgery is associated with changes in specific symptoms and triggers. This information can assist in trigger avoidance and contribute to constellations used for frontal migraine headache trigger-site identification.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Cleveland, Ohio.|From the Departments of Plastic Surgery and Statistics and Epidemiology, Case Western Reserve University School of Medicine; and the Department of Plastic Surgery, University Hospitals Case Medical Center.
authors.forename: David E
authors.initials: DE
authors.lastname: Kurlander
authors.affiliation: Cleveland, Ohio.|From the Departments of Plastic Surgery and Statistics and Epidemiology, Case Western Reserve University School of Medicine; and the Department of Plastic Surgery, University Hospitals Case Medical Center.
authors.forename: Mona
authors.initials: M
authors.lastname: Ascha
authors.affiliation: Cleveland, Ohio.|From the Departments of Plastic Surgery and Statistics and Epidemiology, Case Western Reserve University School of Medicine; and the Department of Plastic Surgery, University Hospitals Case Medical Center.
authors.forename: Abdus
authors.initials: A
authors.lastname: Sattar
authors.affiliation: Cleveland, Ohio.|From the Departments of Plastic Surgery and Statistics and Epidemiology, Case Western Reserve University School of Medicine; and the Department of Plastic Surgery, University Hospitals Case Medical Center.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D005625:Frontal Lobe; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000503:physiopathology* / Q000601:surgery*; D009410:Nerve Degeneration; D019635:Neurosurgical Procedures / Q000379:methods; D011182:Postoperative Care; D011183:Postoperative Complications; D011184:Postoperative Period; D016896:Treatment Outcome