Endoscopic decompression surgery of the supratrochlear nerve (STN) and supraorbital nerve (SON) can effectively alleviate frontal chronic headaches long-term in patients who are unresponsive to more general treatment methods, according to a study published in JAMA Facial Plastic Surgery.

Boris Filipović, MD, PhD, of the Department of Otorhinolaryngology-Head and Neck Surgery, at the Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital in Utrecht, Netherlands, and associates conducted a prospective group analysis to determine and compare the efficacy of oral medication, botulinum toxin type A (BoNT/A) injections, and endoscopic decompression surgery to treat patients with STN and SON-related frontal secondary headaches.

A total of 22 patients (average age, 42 years; 7 men and 15 women) with moderate to severe frontal headaches occurring more than 15 days per month—characterized as exacerbating when additional pressure is applied to the STN or SON regions—were included. Moderate to severe pain intensity was measured with visual analog scale (VAS) scores between 7 and 10.

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The participants were given various oral medications and BoNT/A injections administered into the corrugator muscle, as well as endoscopic surgery performed by a single surgeon to liberate the supraorbital ridge periosteum and bluntly dissect the glabellar muscles.

The primary outcomes were VAS scores postoral and injection. In addition, daily headache questionnaires were reported at 1 year follow-up after surgery.

Oral medication significantly reduced headaches with an average VAS score of 6.45, compared with an average baseline score of 8.13. BoNT/A injections also decreased VAS scores from an average baseline of 8.1 to an average posttreatment score of 2.9. At 3 and 12 months of surgical treatment VAS scores were reduced from baseline of 8.1 to 1.30 and 1.09, respectively.

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“Endoscopic decompression surgery has a long-lasting successful outcome in this type of frontal secondary headache,” wrote the authors. “Even though BoNT/A had a positive effect, the effect of surgery was significantly higher.”


Filipović B, de Ru JA, Hakim S, van der Langenberg R, Borggreven PA, Lohuis PJFM. Treatment of frontal secondary headache attributed to supratrochlear and supraorbital nerve entrapment with oral medication or botulinum toxin type A vs endoscopic decompression surgery. [Published online May 10, 2018]. JAMA Facial Plast Surg. doi: 10.1001/jamafacial.2018.0268