Estrogen-Associated Headaches Can Be Treated by Surgery: A Multicenter Retrospective Cohort Study.
Academic Article
Overview
abstract
BACKGROUND: Nerve decompression surgery has been successful in treating headaches refractory to traditional medical therapies. Nevertheless, a subset of patients remain unresponsive to surgical treatment. METHODS: We conducted a retrospective chart review of the two senior author's (J.E.J. and W.G.A.) patient data from 2007 to 2020 to investigate differences in surgical outcomes in women reporting estrogen-associated headaches - headaches associated with menstrual period, oral contraceptives, pregnancy, other hormonal drugs - compared to those who did not. For these two groups, we used Migraine Headache Index (MHI) as the metric for headache severity and compared the mean percent change in MHI at 3 months and 1 year. RESULTS: Of the 99 female patients who underwent nerve decompression surgery and met inclusion criteria, 50 of the patients reported estrogen-associated headaches and were found to have significantly earlier age of onset (p=0.017) and initial presentation to clinic (p=0.046). At 1-year post-op, the majority of patients improved more than 80% after surgery (67%), but there were a subset of patients who improved less than 5% (12.5%). We did not find a significant difference in percent change in post-op MHI between women with estrogen-associated headaches and those without such headaches. CONCLUSION: Women with estrogen-associated headaches have surgical outcomes comparable to women without this association. Nerve decompression surgery should be offered to women experiencing estrogen-associated headaches as an option for treatment.
