**Author details**

approach for frontal migraine therapy should be considered as the first choice since it has been demonstrated that odds ratio for improvement or elimination is higher if compared with the transpalpebral access [4–6, 12–15]. Trans-palpebral nerve decompression should be performed

Chepla and coworker showed that patients presenting supraorbital foramen instead of the supraorbital notch experienced higher success rate after resection of the glabellar muscle group with foraminotomy, thus supporting the hypothesis that the supraorbital nerve may be

Furthermore, it emerged that some factors may affect the surgical outcome. Migraine surgery failure seems to be associated with increased intraoperative bleeding, surgery on fewer trigger sites, and history of significant head and neck trauma, while older age of migraine onset, higher rate of visual symptoms, surgery at Site I or II, and deactivating all four operative sites are associated with migraine surgery success [5, 8, 9]. The exact relationship between history of head and neck trauma, age of onset, visual symptoms, and response to surgery is not understood. Patients complaining multiple trigger sites will undergo multiple decompression surgeries addressing even minor triggers; this is likely the explanation for better outcome associated with greater number of operative locations. Intraoperative bleeding may interfere with optimal surgical outcome by promoting scar tissue formation. Intraoperative bleeding and blood pressure must be controlled aggressively in order maximize success rate. MH characteristics (e.g., frequency, duration, and amount of drugs needed) also seem to affect the surgical outcome; milder MH have higher chances of improvement in comparison to more severe ones, which are more likely to recur postoperatively [5, 8, 9]. Preliminary Botox

Migraine surgery is regarded as a minimally invasive procedure; thus, no concerning side

All patients undergoing frontal decompression surgery with endoscopic approach will experience frontal and upper eyelid edema of various degrees. Usually the edema resolves by the fifth postoperative day. Ecchymosis of both upper and lower eyelids and zygotic regions also follows surgery and usually vanishes by the second postoperative week. No treatment needs to be given as these collateral events resolve by themselves; boric water applications three times a day may help the process of reabsorption of the edema. As previously stated, the only hypothetical serious complication that may occur within the 12 h following the surgery is the compression of the optical nerve due to the drop of the edema into the posterior orbicular space whenever the subgaleal dissection is carried out beyond the orbital rim. Prompt recognition of patient's sight modification is mandatory in order to urgently decompress the optic nerve. Decreased glabellar muscle activity till complete elimination may occur depending on the technique applied. Slight asymmetric eyebrow movement may be also noted [6]. Patients

when a forehead length of 8 cm or more contraindicates the endoscopic approach.

constricted within the foramen leading to frontal migraine headaches [5].

infiltration does not affect the surgical success [10].

112 Current Perspectives on Less-known Aspects of Headache

**6. Complications**

effects are usually reported.

Edoardo Raposio\* , Nicolò Bertozzi, Chiara Bordin and Francesco Simonacci

\*Address all correspondence to: edoardo.raposio@unipr.it

Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Plastic Surgery Chair, University of Parma, Parma, Italy
