Current Evidence

  • Thomas Muehlberger


The average success rate of migraine surgery, measured as either headache cessation or a substantial improvement, is higher than 80%. These results have been reproduced by multiple surgeons at multiple institutions. The quality of the evidence, however, does not match the unambiguity of the results. The majority of studies are retrospective, observational case series. There are several reasons for the current dearth of prospective, controlled trials in migraine surgery. Funding is a major obstacle. While manufactures of migraine medications are backing almost any trial on their products, they are an unlikely source of support of a surgical option. The multitude of co-variables among migraine patients are difficult to control in matched groups. The heterogeneity of surgical interventions is challenging the comparability of results. The only real equivalent of double-blind, randomized, controlled trials is sham surgery. Although perfectly feasible to evaluate the efficacy of procedures, sham surgery trials are very rarely granted approval by ethics commissions. Enthusiasts are generating better results than skeptics. The development of a standardized approach and the conduction of multicenter placebo surgery trials in alliance with neurologists would be a highly desirable future step for the benefit of migraine patients.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Thomas Muehlberger
    • 1
  1. 1.Medsteps AGChamSwitzerland

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