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Study finds migraine surgery reduces the number of days with headaches
Last reviewed: 02.07.2025
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For patients with chronic migraine, nerve decompression surgery effectively reduces the number of headache days — the preferred metric for neurologists — as well as other measures, including the frequency and intensity of migraine attacks, according to a study published in the June issue of the journal Plastic and Reconstructive Surgery. The article is titled, "Comparison of the Migraine Headache Index and the Number of Migraine Days Per Month After Nerve Decompression for Headache Treatment: A Systematic Review and Meta-Analysis."
"Neurologists evaluating migraine treatment tend to focus on reducing the number of headache days, whereas plastic surgeons performing headache surgery are more likely to use a measure that includes other headache measures, such as the Migraine Headache Index," said ASPS member and professor of plastic surgery, surgery, neurosurgery, and neurology Jeffrey E. Janis, MD, of The Ohio State University Wexner Medical Center in Columbus.
"Our study adds new evidence that headache surgery improves both sets of outcomes, providing a more comprehensive assessment of headache surgery outcomes."
What outcomes does headache surgery improve?
Peripheral nerve decompression surgery—sometimes called trigger point deactivation or headache surgery—has become an established surgical treatment for chronic migraine and some other neurological causes of headache, such as occipital and supraorbital neuralgia. Migraine surgery aims to relieve compression of nerves in trigger points of the head and neck that are thought to contribute to headaches.
When plastic surgeons evaluate the results of headache surgery, they typically use the Migraine Headache Index (MHI), which measures the frequency, intensity, and duration of migraine attacks. In contrast, neurologists — "the traditional experts in nonsurgical migraine treatment" — focus on changes in the number of migraine days per month.
"This discrepancy is one reason why some headache specialists have been slow to acknowledge the growing evidence for the effectiveness of headache surgery," says Dr. Janis. Current guidelines do not recommend rating headache intensity or duration, citing a lack of standardization.
Strong evidence for the effectiveness of headache surgery
To help bridge the gap between specialties, the researchers reviewed 19 headache surgery studies that provided information on the number of migraine days per month. The studies, conducted from 2005 to 2020, included a total of 1,603 patients. Five of the studies were randomized controlled trials, which is the highest level of evidence in studies.
Of the eight studies assessing the number of migraine days per month before and after migraine surgery, six showed a significant reduction in the number of migraine days. In a weighted analysis, patients had an average of 14.11 fewer migraine days per month, before and after surgery. Based on 12 studies, the total number of migraine days per month was reduced by 8.65.
Other measures also improved after headache surgery, including a mean reduction in the MHI total score of 76.59 points (out of a maximum of 300 points). This included improvements in migraine intensity, which decreased by an average of 3.84 points (on a scale of 0 to 10); and attack duration, which decreased by 11.80 hours per month. The studies did not report any serious complications from headache surgery.
The study "demonstrates the effectiveness of headache surgery across metrics used in both the plastic surgery and neuroscience literatures," Dr. Janis and his co-authors conclude. They acknowledge some limitations of their study — particularly including the variability of trigger zones addressed by headache surgery. Still, the results "provide strong evidence for the effectiveness of headache surgery."
"We hope that our study will help facilitate communication between plastic surgeons and neurologists in evaluating the effects of headache surgery on patients with chronic headache," comments Dr. Janis. "Future headache surgery studies should routinely include data on the number of migraine days per month to better compare the results of surgical and medical treatments."