Peripheral Nerve Surgery for Chronic Headache: A Comprehensive Evaluation of Safety and Effectiveness

Abstract

Objectives Headache, a prevalent chronic neurological disorder, often leads to diminished quality of life and functional impairment in patients unresponsive to pharmacological interventions. Peripheral neurectomy, emerging as a potential surgical solution, addresses trigger points contributing to headaches due to trigeminal autonomic cephalalgias and migraine. This study comprehensively evaluates the effectiveness, functional outcomes, and cost-effectiveness of peripheral neurectomy in chronic or drug-refractory headache patients.

 Material and Methods A prospective observational study conducted from December 2019 to May 2023 enrolled 51 patients with chronic or drug-refractory headaches responding positively to a bupivacaine block. Primary outcomes assessed pain reduction using the Migraine Headache Index (MHI) and Visual Analog Scale (VAS). Secondary outcomes included functional improvement (Migraine Disability Assessment [MIDAS] and Pain Self-Efficacy Questionnaire [PSEQ]) and postoperative complications. Patient selection criteria involved a positive response to the bupivacaine block and exclusion for patient refusal.

Results Of the 51 patients, 33.33% achieved complete freedom from headaches, and 62.74% experienced over 70% relief, allowing cessation of prophylactic therapy. Baseline MHI (515.88  242.99) significantly decreased to 4.37  4.02 (p < 0.001) and remained low at 3.68  3.60 (p < 0.001) during the 6-month follow-up. The VAS scores decreased from 7.16  1.05 to 1.29  0.5 (p < 0.001). The MIDAS score decreased from 16.86  6.05 to 0.19  0.44 (p < 0.001), and the PSEQ score increased