Understanding Migraine Trigger Sites

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Migraine headaches are a severely disabling phenomenon.  Over 324 million people are affected worldwide.  Migraines rank at the 20th leading cause of years lost due to disability worldwide.  For decades the only available treatments included avoidance of common migraine triggers and medications.  Medications are effective for most, but come with side effects such as fatigue and dizziness.  Fortunately, there is a new and powerful weapon in the treatment of migraine headaches.

Migraine surgery has achieved improvement in 75-90% of sufferers in peer reviewed scientific studies.  This has revolutionized the concept of the origin of migraine headaches and has already improved the lives of thousands of American men and women.  For decades, migraines were thought to originate from an internal (in the brain) trigger.  It is now understood that external trigger points (outside the brain) can cause the migraines by pinching sensory nerves as they cross various muscles and anatomic boundaries.

Trigger Site 1:  The Frontal Zone

The frontal zone is the most common site for external trigger of migraine headaches.  It can be accessed through a crease in the upper eyelid or endoscopically through tiny incisions behind the hairline.  This allows me to decompress the sensory nerves traveling under or through the muscles that cause the frown lines between your eyebrows.  The scientific names of these muscles are the corrugator supercilii, corrugator depressor, and procerus muscles.  After the surgery, numbness and tingling can be experienced.  These are usually temporary side effects until the swelling resolves.

Trigger Site 2:  Temporal Zone

A very small sensory nerve that supplies sensation to skin of the temple can be a trigger of migraine headaches.  This can be aggravated by stress and teeth grinding.  This nerve becomes pinched in the temporalis muscle.  I simply remove a small segment of this nerve.  The numbness is permanent but usually goes unnoticed by most patients.

Trigger Site 3:  Occipital Zone

This area can be exacerbated by stress also.  Tightening of the semispinalis capitus muscle around the occipital nerve in the posterior neck can cause migraine headaches.  By releasing this tiny muscle and redirecting the nerve into the nearby soft fat, compression can be relieved and migraine trigger from this site can be eliminated.

Trigger Site 4:  Nasal Zone

I may order a CT scan to evaluate this trigger site completely.  Some patients can experience pain and migraine trigger from deviated septum combined with overgrowth of an area of the nose called the turbinates.  When these two areas become inflamed with allergies or stress, contact can cause compression.  Compression can cause pain that leads to development of a migraine headache.

These trigger sites account for an estimated 75-90% of all migraine triggers in the head and neck.  Over a dozen minor sites have also been described and can be explored if these sites do not relieve the migraines.

If you are interested in migraine surgery, I encourage you to schedule a consultation.  During the consultation, I will perform a focused history and physical exam pertaining to migraine trigger sites.  We will review past treatments and start keeping a migraine journal.  We will then explore procedural options to help you regain control of your life.

 

–Jason Mussman MD

 

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