Treatment of dopplerable nummular headache with minimally invasive arterectomy under local anesthesia

Publication date: Available online 12 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Bahman Guyuron, James Gatherwright, Deborah Reed, Hossein Ansari, Rebecca Knackstedt
ObjectiveThe objective of the current study is to elucidate the potential role of surgery in the treatment of nummular headache.BackgroundNummular headache is a disorder in which pain is localized to a specific area. Treatment has historically been medical, with the recent addition of nerve blocks and botox injection with equivocal results.DesignForty-nine patients were identified using the International Classification of Headache Disorders, third edition version β. Patients were asked to identify their area of maximal pain. Patients who had an associated Doppler signal within the area of pain underwent surgical arterectomy using local anesthesia. Pre- and post-operative headache frequency, severity, duration, and headache-free days were analyzed.ResultsThere were a total of 49 patients included in the study (42F:7M) with an average age of 45 years (21 – 65). The average follow-up was 16 months with a range of 8 – 33 months. There was a significant reduction in the frequency (-10.7 days; p < 0.001), severity (-3.5; p < 0.001) and duration (-0.3 hours; p=0.4). There was a significant increase in the number of headache-free days per month (10 vs. 21; p < 0.001). Headache index decreased by 39.6%, from an average of 378.6 to 228.4 (p<0.05). Twelve patients (24.5%) were NH free and able to discontinue their medications. There were no complications identified within the follow-up period.ConclusionsNummular headaches, while rare, can be associated with significant disability despite current treatment modalities. In select patients, surgical arterectomy is a safe, minimally invasive, and effective treatment for nummular headache.