ABSTRACT
Background Prior case reports have indicated that treating thoracic outlet syndrome (TOS) may relieve intractable migraine headaches, but the reported experience has been limited. We report in a large case series how a strategy of treating concurrent TOS can help relieve intractable migraine headaches in patients with these dual diagnoses.
Methods Retrospective chart review for diagnostic and interventional data on patients with migraine and TOS followed by a questionnaire to investigate specific migraine features and changes in headache burden before and after treatment of TOS.
Results 50 patients (48 women, 2 men, age = 43.9+/12.7years) with dual diagnoses of chronic migraine and TOS were included (20 migraine with aura, 28 migraine without aura, two hemiplegic migraines). Based on review of available data, headaches had become chronic within one year of onset in 21 patients (42%) and included these characteristics: side-locked or greater severity ipsilateral to limb paresthesia (38/50 patients), presence of limb swelling (32/48 patients), and worsened by recumbency (32/38 patients). Interventions included physical therapy, percutaneous transluminal venoplasty, 1st rib removal, scalenectomy, pectoralis minor tenotomy, and vein patching. Thirty-two patients needed surgery. Mean patient-reported improvement of headaches on the treated side was 72+/-26.7%; 12 patients experienced complete resolution of headaches after surgical treatment of TOS (follow-up 7.2+/-5.2 months). Questionnaire responders reported significant reductions in headache days (18.3+/-8.6 to 11.1+/-10.8 days/month, p<0.0016), severity (7.8+/2.5 to 5.4+/-2.9, p<0.00079), and need for emergency care (3.6+/-4.0 to 0.71+/-1.3 visits/year, p<0.0029) after having had their TOS treated with surgery. Questionnaire responders and non-responders were not significantly different in underlying clinical features.
Conclusion Chronic migraines can be important manifestations of TOS. Early transition to a chronic state, headaches worsened by recumbency, and headaches with lateralized myofascial pain are clues to a contribution by TOS pathology. The TOS contribution to migraine has been under-recognized. Addressing it can significantly improve migraine headache burden.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This study did not receive any funding
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Saint Francis Health Systems Institutional Research Ethics Board with protocol number 2250-19. Informed consent was obtained from all participants with research performed in accordance with the Declaration of Helsinki.
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Footnotes
Conflict of interest: The authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
There are mostly editorial changes for wording but no substantial changes to the content. We just felt that some of the sentences could be better worded.
Data Availability
Availability of data and materials: The dataset supporting the conclusions of this article is available in the Harvard Dataverse.
https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/Y4AEPL