News — November 29, 2022 – Patients who undergo surgery for carpal tunnel syndrome and other upper extremity nerve compression syndromes are more likely to be diagnosed with migraines, reports a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.
The findings add to previous evidence of a possible “shared predisposition” between migraine and upper extremity nerve compression syndromes, according to the report by ASPS surgeon member Kyle R. Eberlin, MD, Lisa Gfrerer, MD , PhD, and colleagues at Massachusetts General Hospital, Harvard Medical School.
Certain types of nerve decompression surgery linked to higher migraine rates
The researchers analyzed data from nearly 9,600 patients who underwent upper limb nerve decompression surgery (arm, wrist and hand) between 2009 and 2019, drawn from a large hospital database. The most common procedure was median nerve decompression (71% of patients), usually performed in patients with carpal tunnel syndrome.
Patients were screened for a diagnosis of migraine. A diagnosis of migraine was more likely in patients undergoing two types of upper extremity nerve decompression procedures: median nerve decompression and multi-nerve decompressions. Overall, 7% of patients with median nerve decompression and 8.8% of those with multiple nerve decompression were diagnosed with migraine.
After adjusting for other risk factors, the odds of being diagnosed with migraine were 30% higher for patients undergoing median nerve decompression and 70% higher for those undergoing multiple nerve decompression (vs. ulnar nerve in the elbow).
Migraine Patients Should Consider Nerve Compression Treatment Options
In recent years, plastic surgeons have developed migraine surgery techniques to relieve nerve compression sites or “trigger points” associated with migraine attacks. According to the researchers, patients who suffer from nerve compression in the extremities, such as carpal tunnel syndrome, and who have been diagnosed with migraine should therefore consider nerve compression as a potential treatment option.
Building on previous studies, the report “provides further evidence for a link between upper extremity nerve compression and migraine,” write Dr. Eberlin and colleagues. Reported associations suggest that patients who develop symptoms related to nerve compression in the arm and hand may also be predisposed to nerve compression at migraine-related trigger points.
Although it is unclear how many patients with migraine also have nerve compression syndromes, “biological and genetic overlap between CTS and migraines is likely,” conclude Dr. Eberlin and coauthors. They call for further studies on the shared mechanisms that could explain the link between the two different types of nerve impingement syndromes. Meanwhile, the researchers write, “It is important that hand and peripheral nerve surgeons recognize migraine as a comorbidity in patients with impingement syndromes and provide comprehensive screening for both disorders.”
Lily [Migraine Headaches in Patients with Upper Extremity Compressive Neuropathy]
About Plastic and Reconstructive Surgery
For more than 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has always been the excellent reference for any specialist who uses plastic surgery techniques or works in collaboration with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-date 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 the ASP
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 source of information on aesthetic and reconstructive plastic surgery. ASPS comprises over 94% 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.
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