Bahman Guyuron1, James Gatherwright2, Deborah Reed3, Hossein Ansari4, Rebecca Knackstedt5. 1. Division of Plastic and Reconstructive Surgery, Case Western Reserve School of Medicine, 29017 Cedar Road, Lyndhurst, Ohio 44124, USA. Electronic address: Bahman.Guyuron@gmail.com. 2. Division of Plastic and Reconstructive Surgery, 2500 MetroHealth Dr, Cleveland, Ohio 44109, USA. 3. Department of Neurology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, Ohio 44106, USA. 4. Department of Plastic and Reconstructive Surgery, University of California, 9500 Gilman Dr, La Jolla, California 92093, USA. 5. Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, Ohio 44195, USA.
Abstract
OBJECTIVE: The objective of the current study is to elucidate the potential role of surgery in the treatment of nummular headache (NH). BACKGROUND: NH is a disorder in which pain is localized to a specific area. Treatment has traditionally been medical, with the recent addition of nerve blocks and botox injection with equivocal results. DESIGN: Forty-nine patients were identified using the International Classification of Headache Disorders, third edition, beta version. Patients were asked to identify the area of maximal pain. Patients who had an associated Doppler signal within the area of pain underwent surgical arterectomy using local anesthesia. Preoperative and postoperative headache frequency, severity, duration, and headache-free days were analyzed. RESULTS: There were a total of 49 patients included in the study (42F:7M) with an average age of 45 years (21-65 years). The average follow-up period was 16 months with a range of 8-33 months. There was a significant reduction in the frequency (-10.7 days; p < 0.001), severity (-3.5; p < 0.001), and duration (-0.3 hours; p = 0.4) of the headache. There was a significant increase in the number of headache-free days per month (10 vs. 21; p < 0.001). Headache index decreased by 39.6%, from an average of 378.6 to 228.4 (p < 0.05). Twelve patients (24.5%) were free from NH and able to discontinue their medications. There were no complications identified during the follow-up period. CONCLUSION: NH, although rare, can be associated with significant disability despite current treatment modalities. In select patients, surgical arterectomy is a safe, minimally invasive, and effective treatment for NH.
OBJECTIVE: The objective of the current study is to elucidate the potential role of surgery in the treatment of nummular headache (NH). BACKGROUND: NH is a disorder in which pain is localized to a specific area. Treatment has traditionally been medical, with the recent addition of nerve blocks and botox injection with equivocal results. DESIGN: Forty-nine patients were identified using the International Classification of Headache Disorders, third edition, beta version. Patients were asked to identify the area of maximal pain. Patients who had an associated Doppler signal within the area of pain underwent surgical arterectomy using local anesthesia. Preoperative and postoperative headache frequency, severity, duration, and headache-free days were analyzed. RESULTS: There were a total of 49 patients included in the study (42F:7M) with an average age of 45 years (21-65 years). The average follow-up period was 16 months with a range of 8-33 months. There was a significant reduction in the frequency (-10.7 days; p < 0.001), severity (-3.5; p < 0.001), and duration (-0.3 hours; p = 0.4) of the headache. There was a significant increase in the number of headache-free days per month (10 vs. 21; p < 0.001). Headache index decreased by 39.6%, from an average of 378.6 to 228.4 (p < 0.05). Twelve patients (24.5%) were free from NH and able to discontinue their medications. There were no complications identified during the follow-up period. CONCLUSION: NH, although rare, can be associated with significant disability despite current treatment modalities. In select patients, surgical arterectomy is a safe, minimally invasive, and effective treatment for NH.
Authors: Lisa Gfrerer; Marek A Hansdorfer; Ricardo Ortiz; Kassandra P Nealon; Christian Chartier; Gem G Runyan; Samuel D Zarfos; William Gerald Austen Journal: Plast Reconstr Surg Date: 2020-10 Impact factor: 5.169