Migrainous Headaches
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Theory of mechanical irritation of peripheral potentially hyperexcited, peripheral
sensory nerves
o Migraine headache is postulated to be caused by dilatation of large
vessels innervated by the trigeminal nerve.
o Vasodilatation is the consequence of release of calcitonin gene–related
peptide, substance P, and neurokinin A, found in the cell bodies of
trigeminal neurons
o Irritation of the peripheral branches of the trigeminal nerve results in
release of substance P and neurokinins which travel along the nerve and
produce a localized meningitis
Guyuron (PRS 2000) reported 80% of patients had relief of migraine symptoms
after corrugator resection
Guyuron (PRS 2002 prospective) 95.5% experienced some degree of
improvement in headache frequency and/or intensity
Nerves involved:
1. frontal region - both supratrochlear (main trunk) and supraorbital
(branches) nerves pierce the corrugator supercilii muscle.
2. temporal region – zygomaticotemporal
 Constricted by temporalis muscle
3. occipital region - greater occipital nerve (medial branch of the C2 dorsal
root)
 Constriction by semispinalis capitis muscle as nerve passes
through it
 This occurs 3 cm below the occipital protuberance and 1.5 cm
lateral to the midline
4. Septonasal trigger sites
 Elimination of friction between a deviated septum and an
enlarged turbinate
 Irritation of intranasal branches of trigeminal
Botox injection useful for confirming the diagnosis
1. may cause temporary temporal hollowing – improves with cessation of
injection
Surgical Treatment (Guyuron PRS Jan 2005)
1. Frontal - glabellar muscle group including the corrugator supercilii,
depressor supercilii, and procerus muscles removed through a palpebral
incision to relieve compression of the supraorbital and supratrochlear
nerves, which traverse these muscles.
2. Temporal - endoscopic removal of 3 cm of the zygomaticotemporal branch
of the trigeminal nerve to prevent its compression by the temporalis
muscle.
 commonly transected during craniofacial or aesthetic forehead
surgery, with no reported consequence.
3. Occipital – Removal of a small portion of semispinatus capitus around the
greater occipital nerve
4. Intranasal - septoplasty and inferior and/or middle turbinectomies based on
intranasal abnormality.
Complications