Who needs a migraine after surgery?

For those with migraine, the presence of many potential triggers can be a daily minefield.  There are avoidable triggers (certain foods, drinks, activities or habits) and there are unavoidable triggers (menstrual cycle, weather or external stress.)  It’s pretty obvious that something like surgery could be a migraine trigger.  Really any physiologic disruption can trip the migraine switch.  A recent article looked at this issue specifically.

In The association between migraine and hospital readmission due to pain after surgery: A hospital registry study, researchers reviewed records from over 150,000 subjects who had surgery for any reason and found that the presence of a migraine diagnosis increased the chances for a readmission to the hospital for pain by 42% over post-operative subjects with no migraine history.  It would therefore seem that surgery is triggering something.  If the data was filtered for  headache or abdominal pain (both of which are seen with migraine attacks) the increased risk was 55%.

This concept was then explored further in a presentation at the 2019 American Headaches Society Meeting in July in which the same team presented data from 22,000 migraine sufferers who had surgery for any reason to look at how pain medication prescription affected readmission rates for pain.  The study found that if a post operative migraine sufferer was given a non-narcotic migraine abortive they were 37% less likely to have a readmission for pain after surgery and if they were given a migraine specific medication such as a “triptan” medication, the figure was a 67% lower likelihood of a pain-related admission.

All this seems intuitive but putting some figures on it is interesting.  In particular, this seems to prove the effectiveness of the migraine specific “triptan” class in dealing with even post operative migraines and keeping people out of a hospital.  This class includes sumatriptan (Imitrex), eletriptan (Relpax), rizatriptan (Maxalt), and others.

Who needs a migraine after surgery?  Who needs a migraine any day?  If you have poorly treated or untreated migraines, best to see your doctor and get access to the very good prescription medications out there to deal with this.  A primary care doctor can be the first stop, but neurologists are expert in this condition and can be a good source of information and relief options.

-DS (5/9/20)