The Auriculotemporal Nerve in Etiology of Migraine Headaches

Abstract

Findings from this cadaver study provide information relevant to the operative localization of potential compression points along the auriculotemporal nerve.

Emergence of Secondary Trigger Sites after Primary Migraine Surgery

“…Since the inception of migraine surgery, the impact of other nerve branches such as the auriculotemporal, third occipital, and lesser occipital has come to play a significant role. 17,18,22,[28][29][30] These anatomical overlaps and irritation of the smaller peripheral branches may cloud the ability to adequately locate the correct site or nerve for decompression. More recently, the senior author has found that a handheld Doppler probe will almost invariably locate an arterial signal near a residual or new pain site, indicating a close association with vascular irritation.…”

The surgical management of cephalalgia

“…The ATN (V 3 ) wraps around the medial posterior aspect of the neck of the mandibular condyles to ascend in the preauricular region into the temporal region. Compression points have been identified in preauricular fascial bands as well as with the tortuous relationship between the superficial temporal artery and ATN [34].…”

Use of a Doppler Signal to Confirm Migraine Headache Trigger Sites

“…7 Three distinct compression points have been identified. The first two relate to preauricular fascial bands described in relation to the external auditory meatus.…”

“…Three nerve-artery relation patterns have been described, including a single site of the artery crossing the nerve, a helical intertwining, and the nerve crossing over the artery. 7,8 The superficial temporal artery runs close enough to the skin surface to allow its signal to be readily detected with an ultrasound Doppler signal. Therefore, combining patient participation in identifying the temporal trigger site with the use of ultrasound Doppler provides the surgeon with a precise target for decompression.…”

“…The auriculotemporal nerve has been identified as one of the potential trigger sites for migraine headaches in some patients. 7,8 Successful identification of peripheral nerves as potential trigger sites for the individual patient depends on many factors, with the most important being patient participation by pointing to the sites of intense pain onset. 9 The patient's ability to specifically identify where the pain starts with one fingertip provides key information for detection of the nerve branch involved in the migraine cascade.…”