Frontal Migraine Surgery: Indications and Results

Recent studies have identified that certain types of migraines, including frontal migraines, may be attributed to the irritation of specific extracranial nerves. This systematic review addresses the following questions: Which surgical techniques are most effective for chronic frontal migraines? How do combined surgical approaches compare to isolated procedures regarding efficacy and complication rates? Our objective is to comprehensively analyze surgical options for frontal migraines, including their success rates and safety profiles. A literature search was performed using the PubMed database, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, to provide a systematic review of the literature on the surgical treatment of chronic frontal site migraine. A total of 756 citations from PubMed were initially identified. After a title and abstract review, records were considered relevant. Following a full-text examination, only 16 articles from the initial research, published between 2000 and 2024, met the inclusion criteria and were included in the systematic review. In total, 1004 patients suffering from Frontal Migraine Headaches (FMH) underwent surgical treatment, encompassing all the established procedures. Surgical interventions for migraine demonstrated significant symptom reduction, with response rates ranging from 57% to 94% across techniques. Various surgical interventions for frontal trigger site migraines demonstrate significant effectiveness, with endoscopic approaches showing higher success rates. Techniques like foraminotomy and the integration of botulinum toxin A may further enhance outcomes. However, multi-center, high-quality studies are needed to standardize techniques, evaluate long-term consequences, and assess patient quality of life post-surgery.