Can you paint your migraine?

September 24, 2020

September 24, 2020 - "Can you draw me a picture of your headache?" may sound like an unusual question - but drawings of headache pain provide plastic surgeons with valuable information on which patients are more or less likely to benefit from surgery to alleviate migraine headaches.

Patients with more "typical" patterns on pain sketches have larger reductions in headache scores after migraine "trigger site" surgery, suggests a new study by Lisa Gfrerer, MD PhD and William Gerald Austen, Jr., MD, and colleagues of Harvard Medical School. The study appears in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Migraine surgery has become an established treatment alternative for some patients with intractable migraine headaches. Developed by plastic surgeons who noticed that some migraine patients had fewer headaches after cosmetic forehead-lift, migraine surgery targets specific trigger sites linked to certain headache patterns. More than 5,200 patients underwent migraine peripheral trigger site surgery in 2019, according to ASPS statistics.

However, it can be difficult to predict which patients will get good results from migraine surgery. Drs. Gfrerer, Austen and colleagues have noticed that there are "pathognomic" pain patterns for each trigger site. "In our experience, a valuable method to visualize pain/trigger sites is to ask patients to draw their pain," the researchers write. In the new study, they analyzed how well the patterns on these pain drawings predict the outcomes of migraine surgery.

The study included 106 patients who made pain sketches as part of their evaluation for migraine surgery. The sketches were reviewed by experienced researchers who were unaware of the patients' headache symptoms or other characteristics, and classified into three groups: One year after surgery, outcomes were assessed using a standard score, the Migraine Headache Index (MHI). Patients with typical or intermediate patterns on their pain drawings had similarly good outcomes: MHI scores improved by 73 and 78 percent, respectively.

However, for patients with atypical pain sketches the results were not as good: only 30 percent improvement in MHI score. Just one-fifth of patients in the atypical group had more than 30 percent improvement after migraine surgery.

The researchers emphasize that pain drawings should be just one part of the standard patient assessment. Migraine patients with atypical pain drawings may still have "compelling reasons" for surgery but should understand that they have lower chances of a positive outcome.

As migraine surgery becomes more widely used, pain sketches could be one way to target those patients most likely to have good outcomes. Drs Gfrerer, Austen and coauthors conclude: "As we continue to develop algorithms to select patients for migraine surgery, patient drawings should be considered as an effective, cheap, and simple-to-interpret tool to select candidates for surgery."
-end-
Click here to read "Patient Pain Sketches Can Predict Surgical Outcomes in Trigger-Site Deactivation Surgery for Headaches."
DOI: 10.1097/PRS.0000000000007162

Plastic and Reconstructive Surgery® is published in the Lippincott portfolio by Wolters Kluwer.

About Plastic and Reconstructive Surgery

For more than 70 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2019 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit http://www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

Wolters Kluwer Health

Related Migraine Articles from Brightsurf:

Disparities in migraine by sexual orientation
Survey data were used to examine the association between sexual orientation (exclusively heterosexual, mostly heterosexual, lesbian, gay or bisexual) and migraine.

Can you paint your migraine?
'Can you draw me a picture of your headache?' may sound like an unusual question - but drawings of headache pain provide plastic surgeons with valuable information on which patients are more or less likely to benefit from surgery to alleviate migraine headaches.

Acupuncture can reduce migraine headaches
Acupuncture can reduce migraine headaches compared to both sham (placebo) acupuncture and usual care, finds a new trial from China published by The BMJ today.

Migraine rats, medical facts
Migraine mechanisms are still far from being fully understood. Escalating data from animal models are 'fact-checking' the neurophysiological and behavioral correlates of the migraine experience in humans, and how they may be affected by current anti-migraine drugs or might translate into new therapies.

Connecting the dots in the migraine brain
This dMRI study pointed to the structural strengthening of connections involving subcortical regions associated with pain processing and weakening in connections involving cortical regions associated with hyperexcitability may coexist in migraine.

Predictors of chronic migraine
A review and meta-analysis found predictors of chronic migraine. Depression, high frequency attacks, medication overuse and allodynia increased the chances for new onset chronic migraine, while annual income -- US$ 50,000 showed a protective effect.

On nitroglycerin, cardiovascular homeostasis and...bam, migraine!
Researchers in Leiden, The Netherlands, found an exaggerated cardiovascular response to nitroglycerin infusion in migraine patients, suggesting an elevated systemic sensitivity to this compound in this population.

All roads lead to migraine
Dr. Samaira Younis, from the Danish Headache Center in Copenhagen, Denmark, shares her research results, which suggests there are no differences between migraine attacks clinical characteristics following administration of 2 different compounds in patients, CGRP and sildenafil, meaning they share common cellular signaling pathways.

Running away from exercise: The curious case of migraine
In spite of the widespread recommendation for regular physical activity as a strategy to manage migraine, for some patients, exercise can instead trigger migraine attacks.

Migraine prevention in children and adolescents
Two medicines already used to prevent migraine in adults also showed efficacy in adolescents with migraine.

Read More: Migraine News and Migraine Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.