Temporal headaches are one of the four known regional migraine areas. The etiology is compression of the zygomaticotemporal nerve (second division of the trigeminal nerve), the auriculotemporal nerve (third division of the trigeminal nerve) or both. Decompression or avulsion of these nerves is a known effective treatment in the properly qualified temporal migraine surgery patient.
The surgical approach to the zygomaticotemporal nerve has historically been from an endoscopic technique where the dissection is done from above. This is often combined with supraorbital nerve decompression and explains why a superior approach has been advocated.
In the My 2016 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘ A Novel Surgical Approach to Chronic Temporal Headaches’. In this report, the authors used a temporal hairline incision to access the zygomaticotemporal and auriculotemporal nerves for decompression or avulsion. Through a small 3.5 cm incision, the zygonaticotemporal nerve located above the deep temporal fascia. If the nerve was healthy, the fascia was opened and the sentinel vein cauterized. If the nerve appeared non-viable it was transected and the cut end buried in the muscle. The auriculotemporal nerve located closer to the incision was treated simlarly. At one year after surgery the Mean Migraine Headache Index dropped from an average of 131 to 52. Almost 90% of the patients experienced a 50% reduction in their headache symptoms. Almost 40% had a complete cure of their migraines. Three patients (roughly15%) had no substantial improvement.
The novelty of this temporal migraine approach is that it is closer to where the zygomaticotemporal nerve is located and allows concurrent access to the auriculotemporal nerve as well. It is a perfectly safe approach that stays below the frontal branch of the facial nerve. The more direct approach better allows the treatment option of decompression or avulsion under better visual access.
Dr. Barry Eppley