Prospective Qualitative Study on Impact of Headache Surgery on Quality of Life: Are We Ready for Headache Surgery Outcome Measures?

Background: Migraines are common and are associated with significant morbidity to patients and cost to the healthcare system. Headache surgery (HS) has emerged as a treatment option for patients with symptoms refractory to medical management, but its impact on patients' quality of life is incompletely understood. This study analyzed, via in-depth prospective patient interviews, patient perceptions of and experience with HS. Methods: Patients with history of migraines who were scheduled for HS were invited to participate in this study. Semistructured interviews were conducted by trained qualitative interviewers in the pre/postoperative periods. Interviews were transcribed verbatim, coded utilizing NVivo 12 Software, and queried to assess the impact of surgery on domains such as work, relationships, headache severity, and medication use. Predominant themes were identified and compared among subjects in the preoperative/postoperative periods. Subjects were recruited until thematic saturation was achieved. Results: Eleven patients were enrolled in this study. Nine patients completed preoperative/postoperative interviews an average of 1 month before and 33 months following surgery. Compared with the preoperative interview, postoperative transcript analysis revealed reduced migraine severity, greater ability to participate in work and personal relationships, improved medication efficacy, and better ability to control headaches. These shifting domains facilitated a transition in patient cognitive allocation with reduced migraine predominance in the postoperative setting. Conclusions: This novel study assessed the impact of HS on the quality of life in a prospective, qualitative manner. Our results suggest that HS may reduce migraine severity, improve patients' ability to work and engage in relationships, and improve patients' mental health overall.