{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:00:23Z","timestamp":1791277223099,"version":"4.1.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2018,9,1]],"date-time":"2018-09-01T00:00:00Z","timestamp":1535760000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JAMA Facial Plast Surg"],"published-print":{"date-parts":[[2018,9]]},"abstract":"\n Importance<\/jats:title>\n Endoscopic surgical decompression of the supratrochlear nerve (STN) and supraorbital nerve (SON) is a new treatment for patients with frontal chronic headache who are refractory to standard treatment options.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate and compare treatment outcomes of oral medication, botulinum toxin type A (BoNT\/A) injections, and endoscopic decompression surgery in frontal secondary headache attributed to STN and supraorbital SON entrapment.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Prospective cohort study of 22 patients from a single institution (Diakonessen Hospital Utrecht) with frontal headache of moderate-to-severe intensity (visual analog scale [VAS] score, 7-10), frontally located, experienced more than 15 days per month, and described as pressure or tension that intensifies with pressure on the area of STN and SON. A screening algorithm was used that included examination, questionnaire, computed tomography of the sinus, injections of local anesthetic, and BoNT\/A in the corrugator muscle.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Different oral medication therapy for headache encountered in the study cohort, as well as BoNT\/A injections (15 IU) into the corrugator muscle. Surgical procedures were performed by a single surgeon using an endoscopic surgical approach to release the supraorbital ridge periosteum and to bluntly dissect the glabellar muscle group.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Headache VAS intensity after oral medication and BoNT\/A injections. Additionally, early postoperative follow-up consisted of a daily headache questionnaire that was evaluated after 1 year.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In total, 22 patients (mean [SD] age, 42.0 [15.3] years; 7 men and 15 women) were included in this cohort study. Oral medication therapy reduced the headache intensity significantly (mean [standard error of the mean {SEM}] VAS score, 6.45 [0.20] [95% CI, 0.34-3.02;\n P<\/jats:italic>\n \u2009<\u2009.001] compared with mean [SEM] pretreatment VAS score, 8.13 [0.22]). Botulinum toxin type A decreased the mean (SEM) headache intensity VAS scores significantly as well (pretreatment, 8.1 [0.22] vs posttreatment, 2.9 [0.42]; 95% CI, 3.89-6.56;\n P<\/jats:italic>\n \u2009<\u2009.001). The mean (SEM) pretreatment headache intensity VAS score (8.10 [0.22]) decreased significantly after surgery at 3 months (1.30 [0.55]; 95% CI, 5.48-8.16;\n P<\/jats:italic>\n \u2009<\u2009.001) and 12 months (1.09 [0.50]; 95% CI, 5.71-8.38;\n P<\/jats:italic>\n \u2009<\u2009.001). There was a significant decrease of headache intensity VAS score in the surgical group over the BoNT\/A group (mean [SEM] VAS score, 2.90 [0.42]) after 3 months (mean [SEM] VAS score, 1.30 [0.55]; 95% CI, 0.25-2.93;\n P<\/jats:italic>\n \u2009<\u2009.001) and 12 months (mean [SEM] VAS score, 1.09 [0.50]; 95% CI, 0.48-3.16;\n P<\/jats:italic>\n \u2009<\u2009.001) after surgery.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Endoscopic decompression surgery had a long-lasting successful outcome in this type of frontal secondary headache. Even though BoNT\/A had a positive effect, the effect of surgery was significantly higher.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n \n 3<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamafacial.2018.0268","type":"journal-article","created":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T12:30:57Z","timestamp":1525955457000},"page":"394-400","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Treatment of Frontal Secondary Headache Attributed to Supratrochlear and Supraorbital Nerve Entrapment With Oral Medication or Botulinum Toxin Type A vs Endoscopic Decompression Surgery"],"prefix":"10.1177","volume":"20","author":[{"given":"Boris","family":"Filipovi\u0107","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands"},{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, University Hospital Sveti Duh, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Alexander","family":"de Ru","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Central Military Hospital, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Hakim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"van de Langenberg","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pepijn A.","family":"Borggreven","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J. 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