The treatment of migraine headaches has undergone new insights in the past decade through the use of surgical decompression of specific peripheral nerves in the head and neck. Through either the use of injectable Botox or muscle resection of the supraorbital or occipital nerves as they exit out from their cranial bone sites, significant and sustained relief has been obtained in selected migraine sufferers. But some migraine headaches are not responsive to treatment at these cranial nerve sites.
One specific migraine patient suffers from pain high in the temple region. This type of pain location suggests that there may be a vascular-mediated peripheral trigger site as there is where there is not only a branch of the trigeminal nerve (auriculotemporal nerve) but also the superficial temporal artery. These two anatomic structures are in close proximity. Could the intersection of the superficial temporal artery and the auriculotemporal nerve be an inciting point for a migraine headache?
This anatomic relationship was investigated and reported in the May 2010 issue of the journal Plastic and Reconstructive Surgery. Using fresh cadaver heads, the superficial temporal arteries and auriculotemporal nerves were dissected out and a topographic map of their relationships was created. In 34% of the cranial heads studied, there was a direct relationship between the artery and the nerve where they crossed each other or became actually intertwined.
Because the superficial temporal artery lies against or is intertwined with the auriculotemporal nerve is some cases, it certainly could cause irritation of the nerve. As the nerve and artery are located in the superficial fascia of the temple, it is easily accessible through small incisions within the temple hairline. The artery could be simply tied above and below the crossing point of the two. This could be a new procedure for the treatment of migraines that have been shown to have a trigger point high in the temporal area.
Anatomic studies of this type continue to show that specific sensory cranial nerves can be a cause of migraine headaches. Decompression through either muscle resection or vascular ligation can be a welcome relief for properly selected patients for plastic surgeons. Diagnostic testing of the temple region as a potential culprit could be done by a 24 hour local anesthetic to determine potential effectiveness of a vascular ligation procedure. While Botox is used for supraorbital and occipital nerve testing, that will not work for temple migraine testing as it is a vascular and not a muscular problem.
Dr. Barry Eppley
Indianapolis, Indiana