"Like a Normal Person Again:" A Qualitative Analysis of the Impact of Migraine Surgery
Jacqueline S. Israel, MD1, Nicole A. Brys, MPH1, Jason Orne, PhD2, Ahmed Salem, MD1, Brooke M. Anderson, MSN3, Alaa A. Ebd-Elsayed, MD1, Jeremy P. Smith, MD1, Ahmed M. Afifi, MD1.
1University of Wisconsin - Madison, Madison, WI, USA, 2Drexel University, Philadelphia, PA, USA, 3Edgewood College, Madison, WI, USA.
Purpose: Outcomes after migraine surgery have been previously assessed using quantitative measurements, including headache questionnaires and the migraine headache index. Qualitative methodologies offer the unique ability to analyze the patient's narrative to assess more complex changes in migraine experience. The purpose of this study was to use qualitative methods to study individuals' experiences with migraines and migraine surgery and to explore patterns of change in patients' experiences of headache. Methods: Patients who previously underwent migraine surgery at multiple sites (e.g. frontal, occipital, and/or zygomaticotemporal) by a single surgeon participated in in-depth, semi-structured interviews. Interviews were audio recorded and transcribed verbatim. A multidisciplinary team with backgrounds in surgery, pain management, internal medicine, and health services research coded transcripts using constructivist grounded theory methodology. The principle of triangulation was applied to data analysis (both in terms of the coding team and when identifying both concordant and discordant examples to support the primary argument) in order to enhance trustworthiness and attempt to minimize bias. To avoid false representation of data, we identified and described both recurring themes and disconfirming cases. Memo writing was performed until saturation of the data was achieved. Results: Twelve subjects were interviewed (70% female). The mean age at time of interview was 48 years (SD 15) and the mean time from surgery to interview was 20 months (SD 8). All participants described improvement in their migraines after surgery, even when they experienced persistent head pain postoperatively. We identified four recurring examples to support this change. First, two themes regarding what changed after surgery emerged: (A.) A change in medication use and/or efficacy after surgery, and (B.) Improvement in at least one of several domains of pain (e.g. frequency, character). These changes lead to improved self-efficacy via two additional themes, including (C.) A new ability to participate in daily activities, and (D.) Improved mental functioning or coping Conclusions: Patients reported significant changes in medication effectiveness following surgery, as well as improvements in one or more domains of pain. These changes resulted in improved headache self-efficacy, including an ability to participate in daily activities. Insight gleaned from patient interviews should inform clinical conversations and may improve shared decision-making by providing perspective on postoperative outcomes that matter to patients.
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