UCLA

Background: Endoscopic Foreheadplasty Surgery (EFS) is a surgery addressing facial aging. Frequent consumers of EFS are females (91%) between ages 35-64. Case reports reveal commonly experienced moderate to severe incapacitating postoperative headache lasting 2-7 days. Headache characteristics, medication management, and impact on emotional and functional status are not well understood. The specific aims for this study were to explore in women following EFS: 1) the intensity, location, quality, and duration of headache; 2) compare EFS headache with migraine; 3) examine medication use and efficacy following EFS; 4) evaluate headache and a) emotional and b) functional outcomes; and 5) evaluate the effect of estrogen levels on headache for patients undergoing EFS.

Methods: Forty-two women (mean age 59.0 � 7.9 years) undergoing EFS were recruited from twelve private cosmetic practices in three California counties. Four interviews with the Acute Short-Form 12v2, and the Headache Questionnaire were conducted on postoperative days (POD) 1, 3, 7, and 30.

Results: Most women experienced headache (93%) which was moderate to severe in intensity (64%). Headache was associated with migraine-like symptoms, including light sensitivity and nausea. Current acute therapy provided inconsistent relief. Most EFS triggered headaches (79 %) met International Classification of Headache Disorders (ICHD) criteria for migraine (with the exception of the requirement for previous episodes and limited duration), even in women with no previous history of migraine. Functional and emotional status deteriorated below baseline level postoperatively. Emotional status returned to baseline levels by POD 7 and functional status by POD 30. Those on hormone replacement therapies (HRT) had lower pain intensity, shorter headache duration, and less associated symptoms than those not on HRT.

Conclusion: The findings confirm women experience significant headache following EFS, which improves by POD 7. EFS headache was consistent with ICHD migraine criteria, providing evidence migraine may have an extracranial trigger. With current management inconsistent in relieving EFS headache migraine therapies may be of benefit. This study also offers evidence that HRT and a history of migraine both influence headache episodes and characteristics. Future investigations applying effective migraine strategies for those with EFS migraine-like headache may lead to improved patient outcomes.