Multiple studies have demonstrated some efficacy of these procedures, but closer evaluation of the methodology of these studies reveals major flaws in study design. In this article, the BI 2536 mw author provides an overview of the procedures and presurgical screening tools, as well as a critical evaluation of 2 of the major studies that have been published. In addition, the author provides his opinion on future study designs that may help to better determine the potential efficacy of these experimental procedures and potential headache subtypes (contact point headache, supraorbital neuralgia, and occipital neuralgia) that may respond to

peripheral decompression surgery. Migraine is the most common primary headache disorder

for which patients present for evaluation and treatment. www.selleckchem.com/products/LDE225(NVP-LDE225).html In US population studies, the prevalence of migraine is estimated to be 18% in women and 6% in men.1-3 Migraine preventative pharmacologic treatments span several different classes, including beta blockers (propranolol, atenolol, nadolol, metoprolol, timolol), calcium-channel blockers (verapamil), anticonvulsants (topiramate, divalproex sodium, gabapentin), tricyclic antidepressants (amitriptyline, nortriptyline, protriptyline), and neurotoxins like onabotulinum toxin type A (BTX). The use of these preventative medications is often limited by contraindications, side effects, and lack of efficacy.[4] In a survey study involving 1165 subjects, 28.3% with episodic migraine (EM) and 44.8% with chronic migraine (CM) were currently using preventive medication, and 43.4% with EM and 65.9% with CM had ever used a preventative medication. The mean number of preventative medications ever used was 2.92 for EM and 3.94 for CM. Based on this study, less than half Clomifene of migraine sufferers are currently using preventative treatment, and medication discontinuation is prevalent for unclear reasons.[5] Given the high prevalence of migraine and inconsistent effectiveness of preventative treatment, a plastic surgeon, Bahman Guyuron, MD, devised 4 surgical

procedures intended to “deactivate migraine headache trigger sites.”[6] The theory behind these procedures is that peripheral nerve compression in the head and neck can serve as a migraine trigger. BTX injections may serve to transiently relieve this hypothetical nerve compression through adjacent muscle relaxation, and surgical resection of compressing adjacent structures may potentially accomplish the same task. These procedures are performed based on headache onset location. For patients whose headaches have an intranasal origin, septoplasty and turbinectomy are performed. For patients whose headaches start in the frontal region, an upper eyelid incision is made in order to remove the corrugator supercilii, depressor supercilii, and procerus.