Frontal endoscopic myotomies for chronic headache.

Recent insights into the pathogenesis of migraine headache substantiate a neuronal hyperexcitability and inflammation involving compressed peripheral craniofacial nerves, and these trigger points can be eliminated by surgery. The aim of this study was to describe a modified, innovative, minimally invasive endoscopic technique to perform selective myotomies of corrugator supercilii, depressor supercilii, and procerus muscles, which turned out to be an effective therapy for migraine and tension-type headaches. Forty-three patients (18-75 years) who experienced 15 or more frontal migraine headaches without aura, tension-type headaches, or new daily persistent headaches each month were enrolled in the study between 2011 and 2013. Of 43 patients, 15 were followed for 2 years. Fourteen patients (93.3%) reported a positive response to the surgery: 5 (33.3%) observed complete elimination, 9 (60%) experienced significant improvement (at least 50% reduction in intensity or frequency), and 1 patient (6.6%) did not notice any change in their headaches. A statistically significant difference was found between our protocol compared with currently performed, more invasive technique (odds ratio, 1.9; 95% confidence interval, 1.151-3.13). According to our data, the modified endoscopic procedure leads to better results, compared to previous techniques, together with eliminating the need for general anesthesia, reducing the invasiveness of the procedure and the number of postoperative scars.