ABSTRACT
BACKGROUND: A subset of patients have been noted to have refractory migraine symptoms in site IV (occipital triggers) following primary surgery. It was postulated that the cause of refractory migraine symptoms is new scar tissue formation causing irritation of the greater occipital nerve. The goal of this study was to determine whether intraoperative corticosteroid injections have the potential to prevent these refractory symptoms. METHODS: A retrospective review of all patients operated on by the senior author (B.G.) from 2000 to 2010 was undertaken. All patients who had site IV decompression and at least 1 year of follow-up were included. Patients were divided into two groups, those who had corticosteroids injected and those who did not. Data analyzed included demographics and preoperative and postoperative migraine headache symptoms review based on the migraine headache questionnaire. RESULTS: A total of 476 patients were included in the study. There were 282 patients in the corticosteroid group and 194 in the no-corticosteroid group. A significant reduction was found in the frequency of migraine headaches (-9.8 versus -8.0; p = 0.03) and the migraine headache index (-92.9 versus -65.2; p = 0.0065). There was no significant reduction in migraine headache duration (-0.50 versus -0.70; p = 0.10) or severity (-3.50 versus -3.80; p = 0.38). CONCLUSIONS: Intraoperative injection of corticosteroids during site IV migraine surgery may reduce migraine frequency and migraine headache index postoperatively. Corticosteroid injection in migraine site IV surgery is an effective adjunctive measure in reducing the migraine headache index. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Cicatrix/prevention & control , Decompression, Surgical/adverse effects , Intraoperative Care/methods , Migraine Disorders/prevention & control , Migraine Disorders/surgery , Nerve Compression Syndromes/prevention & control , Postoperative Complications/prevention & control , Spinal Nerves/physiopathology , Triamcinolone Acetonide/therapeutic use , Adult , Anti-Inflammatory Agents/administration & dosage , Cicatrix/etiology , Drug Evaluation , Female , Humans , Injections, Intralesional , Male , Middle Aged , Migraine Disorders/etiology , Nerve Compression Syndromes/etiology , Pain Measurement , Postoperative Complications/etiology , Postoperative Complications/surgery , Recurrence , Retrospective Studies , Surgical Flaps , Surveys and Questionnaires , Suture Techniques , Triamcinolone Acetonide/administration & dosageABSTRACT
A Perda Auditiva Induzida por Ruído (PAIR) é uma das patologias ocupacionais de maior prevalência em nosso país, podendo ocasionar prejuízos na produtividade e qualidade de vida dos trabalhadores. Contudo, existem ainda diversas controvérsias sobre esta doença, além da escassez de estudos acerca de sua história natural nos trabalhadores brasileiros, sendo necessária a importação de dados, nem sempre condizentes com a nossa realidade. Realizou-se análise retrospectiva de prontuários de trabalhadores atendidos no Departamento de Saúde do Trabalhador de Juiz de Fora, com queixa auditiva e/ou suspeita de perda auditiva relacionada ao trabalho, durante o período de 1998 a 2000. A realização deste estudo possibilitou melhor caracterização dos trabalhadores acometidos, permitindo conhecimento sobre o comportamento de algumas das principais variáveis relacionadas à PAIR em nosso contexto, tais como tempo de exposição ao ruído ocupacional, idade, ramo de atividade e uso de protetor auricular.