Chirurgie et migraine : revues de la littérature des traitements préventifs interventionnels relatifs à l'exercice du plasticien

Abstract : Objective: To assess the efficacy of botulinum toxin and surgical nerve decompression as a prophylactic treatment of migraine headaches and define the role of the plastic surgeon on migraine. Methods: MEDLINE, EMBASE, COCHRANE Library were browsed in order to find randomized, double-blind, placebo-controlled trials which compared patients receiving botulinum toxin versus placebo injections in head and neck muscles as a preventive treatment of migraine. We made a second search, including all type of studies, to evaluate the effect of nerve decompression on migraine. Results: For the botulinum toxin analysis, the 17 studies included 3646 patients. Overall analysis reported a tendency in favour of botulinum toxin over placebo at 3 months with a mean difference in migraines frequency change of: -0.23 (95%CI, -0,47 to 0.02; p= 0.08). The analysis of chronic migraines frequency (per month) retrieved significance at 3 months but also since 2 months as well. It also highlighted the improvement of patient’s quality of life at 3 months in the Botox group (p<0.00001). In the surgery review, we included 34 studies, in which 3033 interventions were realized. We retrieved more than 80% operated patients who described an improving of more than 50%. Those two interventional treatments were safe and well-tolerated, with few and mild adverse events. Conclusion: This meta-analysis reveals that Botulinum toxin injections is superior to placebo on chronic migraines at 3 months, which is also found since 2 months, and show for the first time a real benefit in patient’s quality of life with few and mild adverse events. Surgical nerve decompression shows encouraging results, but need further analysis to be assessed.
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Master Thesis
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Éva Bruloy. Chirurgie et migraine : revues de la littérature des traitements préventifs interventionnels relatifs à l'exercice du plasticien. Chirurgie. 2018. ⟨dumas-02066586⟩

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