Pain Sketches Can Help Migraine Patients in Surgery

Migraine patients who draw their pain sites are likely to benefit from migraine surgeries. They have a more considerable reduction in headache scores.

Patients who draw their headache pain provide plastic surgeons with valuable information that have a larger reduction in headache scores after migraine surgery, according to a new study by Harvard Medical School. //

The study is published in the journal Plastic and Reconstructive Surgery.

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‘Migraine patients who have typical and intermediate pain sketches have a high chance of benefiting from migraine surgery. Patients with atypical pain sketches have a lower chance of benefiting from surgery. Patient drawings of pain could be used as an effective, cheap, and simple-to-interpret tool to select candidates for surgery.’
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Migraine surgery has become an alternative treatment for patients with intractable migraine headaches. Plastic surgeons target specific trigger sites that are linked to certain headache patterns.

According to the American Society of Plastic Surgeons, more than 5,200 patients underwent migraine peripheral trigger site surgery in 2019.

There are ‘pathognomic’ pain sites for each trigger site. The authors wanted to analyze how well do the patterns in patients drawings help predict the outcome of migraine surgery.

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The study consisted of 106 patients who made pain sketches as part of their evaluation for migraine surgery.

The pain sketches were reviewed by experienced researchers who were unaware of the patients’ headache symptoms or other characteristics. The researchers classified the pain sketches into three groups:

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Typical – This group consisted of 59% of the sketches showing pain originating from and spreading along the expected path of a specific nerve
Intermediate – This group consisted of 29 % of the sketches showing pain along the path of the nerve, but with an atypical spread of pain
Atypical – This group consisted of 12 of the sketches showing pain originating and radiating outside of the expected nerve distribution

The outcomes of the surgery were assessed a year later using a standard score, the Migraine Headache Index (MHI).

Patients with typical or intermediate pain patterns in their drawing had good outcomes where the MHI scores improved by 73% and 78% respectively.

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The results were not so good in patients with atypical pain were just one-fifth of the patients had a 30 % improvement in MHI score.

The researchers state that the pain drawings should be used as a part of the standard patient assessment. Patients with atypical pain should understand that they have lower chances of a positive outcome after the surgery.

“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,” the authors conclude.

Source-Medindia