Scalp periarterial saline efficacy in migraine and relation to exploding and imploding headache

Abstract

We recently reported the possibility of blocking a migraine attack by prolonged compression of scalp arteries and by the injection of saline around them, suggesting a role of extracranial structures in migraine pain. This study attempts further characterisation of the effect of saline infiltration and the relationship of the response to headache characteristics. A total of 40 patients were examined for scalp artery tenderness (superficial temporal main trunk and frontal branch, and occipital) during migraine attacks. Pain characteristics (implosive vs. explosive) were also evaluated. On the basis of the reported pain location and artery compression performed in order to evaluate which one was possibly more involved in causing pain, periarterial infiltration was effected, 3-5 ml adjacent to each artery, beginning with the one believed to be more involved. Periarterial infiltration of 3-5 ml of saline caused relevant improvement in 82.5% of patients, with complete cessation of pain in 52.5% and >50% relief in 30.0%. Infiltration around only the superficial temporal arteries had the greatest effect in 35.0% of patients. No relationship between the type of pain and response to infiltration was noted. Our results confirm the possibility of obtaining relief from migraine pain using simple saline infiltration around scalp arteries, without drugs, in a large percentage of patients. Moreover, they suggest that at least in a substantial percentage of patients pericranial structures (probably the periarterial nociceptive afferents) are involved. The type of pain reported, implosive versus explosive, does not correlate with response to saline infiltration.

Imploding and Exploding Migraine Headaches: Comparison of Methods to Diagnose Pain Directionality

“…However, in this study, there was no difference in headache directionality in patients who reported the use of prophylactic medications compared with those who did not. Concerns have previously been raised regarding an individual patient's ability to adequately and consistently describe headache pain and its directionality . Our study supports these concerns and suggests the need for further development and study of methods to assign migraine pain directionality.…”

“…Concerns have previously been raised regarding an individual patient's ability to adequately and consistently describe headache pain and its directionality. 6,10 Our study supports these concerns and suggests the need for further development and study of methods to assign migraine pain directionality.…”

“…3,4 Headache pain directionality has been explored as a headache characteristic that may be useful in predicting treatment response. 3,[5][6][7][8] Initial reports from 2006 showed a marked difference in response to onabotulinumtoxin A between patients describing imploding vs exploding migraine headache. 3 Responders were more likely to describe their headache as "imploding or ocular," while nonresponders were more likely to describe "exploding" headache.…”

“…The direction that a patient feels their headache, such as from the outside of the head inward (ie, imploding) or from deep inside the head outward (ie, exploding), may reflect differences in the underlying pathogenesis of individual migraine attacks among and within individuals . Headache pain directionality has been explored as a headache characteristic that may be useful in predicting treatment response 3,5‐8. Initial reports from 2006 showed a marked difference in response to onabotulinumtoxin A between patients describing imploding vs exploding migraine headache .…”

“…The best methods to differentiate imploding, ocular, and exploding headache types in migraine sufferers have not been systematically explored. Clinical observations regarding the difficulty with correct assignment of headache directionality have been discussed in the literature . Clinicians have observed that headache patients often have difficulty consistently describing and assigning directionality to their headache pain .…”