A Comparison Of Outcomes In Trigger Site Deactivation Surgery: A Systematic Review And Meta-analysis Of The Migraine Headache Index Versus Monthly Migraine Days
Benjamin Ormseth, BS1, Hassan ElHawary, MD, MSc2, Maria Huayllani, MD1, Jeffrey Janis, MD, FACS1.
1The Ohio State University Wexner Medical Center, Columbus, OH, USA, 2McGill University Health Center, Montreal, QC, Canada.
PURPOSE: To foster common communication between plastic surgeons and neurologists alike by assessing the effect of trigger site deactivation surgery on monthly migraine days (MMD), the preferred outcome measure of neurologists, compared to outcomes traditionally reported in the plastic surgery literature.
METHODS: An updated literature search was performed according to the PRISMA guidelines. The National Library of Medicine (PubMed), Scopus, and EMBASE were systematically searched for relevant articles. Data was extracted and analyzed from studies which met the inclusion criteria.
RESULTS: A total of 19 studies were included in this review. There was a significant overall reduction in monthly migraine days (mean difference [MD] 14.11, 95% CI 10.95 to 17.27; I2 = 92%, Figure 1), migraine headache index (MD 76.59, 95% CI 60.85 to 92.32; I2 = 98%, Figure 2), migraine intensity (MD 3.84, 95% CI 3.35 to 4.33; I2 = 98%), and migraine duration (MD 11.80, 95% CI 6.44 to 17.16; I2 = 99%) at follow-up (range 6-38 months).
CONCLUSION: : This study demonstrates the efficacy of trigger site deactivation surgery on outcomes reported by both the plastic surgery and neurology communities. We hope this will open a common conversation and lead to optimized management for treatment-refractory migraine patients. 
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