Migraine Triggered Following Endoscopic Foreheadplasty Surgery

Sunday, 27 July 2014: 1:15 PM

Julia Lassegard, RN, CRNA, MS
UCLA School of Nursing, University of California, Los Angeles USA, Los Angeles, CA


Purpose: The purpose was to examine headache pain experienced by women following EFS, an extracranial surgical dissection involving the trigeminal nerve.

Specifically, this study described: 1) intensity, location, quality, and duration of headache pain; 2) compare headache experience following EFS with migraine; 3)

examine medication use and perceived relief; 4) to evaluate the relationship between headache pain and a) emotional status and b) functional status; and 5) to

evaluate the effect of estrogen levels on headache for women following endoscopic foreheadplasty surgery (EFS).

Methods: Forty-two women (44-74 years of age) undergoing EFS were recruited from ten cosmetic surgeon private practice offices in three southern California
counties. Four telephone interviews were conducted on postoperative days 1, 3, 7, and 30 using two questionnaires, the Acute Short-Form 12v2 and Headache


Most women experienced bilateral headache (97%), with the majority reporting severe to moderate pain (71%), which was not consistently relieved with prescriptive

strategies. Most women 78% (N=33) experience pain with symptoms meeting International Headache Society Criteria for migraine or probable migraine for. Physical

health scores were significantly below normal on postoperative days (POD) 1, 3 and 7 (p<0.05), and had recovered on POD 30. Mental health scores were below

normal on postoperative days 1 and 3, returning to baseline by POD seven. These study findings present for the first time evidence that migraine can occur from

extracranial events.


Women experience pain following EFS, which is usually similar to migraine. This similarity suggests that, for some patients, migraine preventives may benefit

management of postoperative headache pain. With regards migraines outside of the context of EFS, these findings raise the possibility that some episodes are initiated

by extracranial events activating the trigeminovascular system. This study also offers more evidence that HRTs and with a history of migraine both influenced headache

episodes and characteristics. It would be of interest to explore if HRTs and history of migraine has influence on other medical conditions and surgical procedures with

and without pain. The findings of major influences of HRT and migraine family history on pain experience suggest these factors may predict varying pain responses to

other medical conditions or procedures. In summary, management of EFS patients postoperatively should address pain which may last for up to a month, and which

may not be well controlled with standard medications.