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Clinical Outcomes Following Supraorbital Foraminotomy for Treatment of Frontal Migraine Headache
Kyle J. Chepla, MD1, Eugene Oh, PhD, ScM2, Bahman Guyuron, MD, FACS1.
1University Hospitals - Case Medical Center, Cleveland, OH, USA, 2Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Purpose: While 92% of patients who undergo surgical decompression of the supraorbital nerve for treatment of frontal migraine headaches through resection of the glabellar muscle group (GMG) achieve at least 50% improvement, only two thirds demonstrate complete resolution of symptomatology. The purpose of this study was to investigate the role of additional decompression methods by comparing surgery outcomes between patients who underwent supraorbital foraminotomy in addition to glabellar myectomy.
Materials and Methods: Outcome measures including; migraine headache frequency, severity, duration, Migraine Headache Index (MHI), and forehead pain were retrospectively reviewed and statistically analyzed for 43 age-matched control patients who underwent glabellar myectomy for release of the supraorbital nerve and 43 patients who underwent glabellar myectomy with supraorbital foraminotomy from 2002-2010.
Results: The myectomy group (M) statistically matched the myectomy with foraminotomy group (MF) for age, number of surgical sites, and pre-operative headache characteristics (p > 0.05). Post-operative migraine frequency per month was 7.8 per month (M) versus 4.1 (MF), severity was 5.6 (M) versus 4.4 (MF), migraine headache index (MHI) was 26.5 (M) versus 11.1 (MF), and persistent forehead pain was 48.8% (M) versus 25.6% (MF). These differences were all statistically significant (p < 0.05). Duration of headache was unchanged (p = 0.17).

Figure 1A. Comparison of pre- and postoperative migraine headache characteristics for all patients (n = 86) at one year follow-up. A significant reduction was seen in all values postoperatively. Mean values ± S.E.M. are shown (*** p < 0.001).

Figure 1B. Comparison of pre- and postoperative migraine headache characteristics by group at one year follow-up. Group MF demonstrated a statistically significant improvement in postoperative migraine frequency, severity and migraine index when compared to group M. Mean values ± S.E.M. are shown (n.s. not significant; *p < 0.05; ** p < 0.01).
Conclusion: The supraorbital foramen is a potential site of supraorbital nerve compression that can trigger frontal MH. If present, we strongly recommend foraminotomy to ensure complete release of the supraorbital nerve to optimize outcomes. Our results also support consideration of release of any fibrous bands across the supraorbital notch.

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