The Efficacy of Migraine Surgery in Reducing Pharmacological Treatment Requirements

Introduction: Migraines impact 35 million Americans, leading to decreased quality of life and are the third leading cause of disability worldwide. Recent studies have demonstrated a nearly 90% success rate for migraine surgery, defined as the elimination or at least a 50% reduction in symptoms. This study aimed to determine the effect of migraine surgery on medication usage. Methods: A national insurance database containing ICD and CPT codes, along with patient demographics, was utilized. Patients diagnosed with chronic migraines via ICD codes were included. Propensity score matching using medical comorbidities created a treatment group that underwent peripheral nerve decompression or transection surgery (CPT-64716 or CPT-64771) and a control group that did not undergo surgery. Medication usage before and after surgery was compared among surgical patients. A logistic regression was performed to identify predictors of undergoing migraine surgery. Results: In a database of 165 million patients, 10,641,115 (6.4%) were identified with migraines. Of these, 1,852 (0.02%) underwent migraine surgery, with a mean and median time to surgery of 3.1 and 2.3 years, respectively (SD 2.8 years). Propensity score matching resulted in 1,948 patients in both control and treatment groups. Post-surgery, the use of abortive medications, including triptans, ergots, and NSAIDs, significantly decreased (p<0.05). Preventative medication use, including beta-blockers, antiepileptics, calcium channel blockers, and antidepressants, also significantly decreased (p<0.01). Conclusions: Peripheral nerve decompression or transection surgery may be effective in reducing medication usage among migraine patients. Further research is needed to assess the impact of migraine surgery on overall healthcare costs.