Validation of the Peripheral Trigger Point Theory of Migraine Headaches: Single-Surgeon Experience Using Botulinum Toxin and Surgical Decompression

Janis, Jeffrey E.; Dhanik, Arjun; Howard, Jessica

doi:10.1097/prs.0b013e3182173d64

Cited by 127 publications

(132 citation statements)

References 49 publications

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“…However, extracranial trigger sites have been recently identified, and decompression of these peripheral trigger sites has been shown to have significant impact on symptomatology. [6][7][8][9][10][11][12][13] There is growing evidence within the field of neurobiology, which supports the concept of a peripheral nerve trigger in the initiation of migraine headaches. 14 A recent study also suggests, through electron microscopy and proteomic analysis, that there are biostructural differences in myelin found in peripheral nerves surgically excised from patients with migraines compared with peripheral nerves from patients without migraines (Guyuron et al, manuscript in preparation, 2014).…”

mentioning

confidence: 96%

“…Botulinum toxin-A (Botox) injections have been recognized and Food and Drug Administration-approved as an effective temporary preventative therapy for chronic migraine headaches, [15][16][17] and surgical decompression or neurectomy of select injection sites has been used to achieve long-term improvement of patients with diagnosed peripheral nerve compression. [6][7][8][9][10][11][12][13] …”

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confidence: 99%

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A Review of Current Evidence in the Surgical Treatment of Migraine Headaches

Janis¹,

Barker²,

Javadi³

et al. 2014

Plastic and Reconstructive Surgery

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107

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Migraines affect 18% of women and 6% of men and result in an estimated $1 billion in medical costs and $16 billion productivity loss in the United States annually. Migraine headaches persist as a problem of this scale because pharmacologic treatments for migraines are frequently incompletely effective, resulting in a population of patients with significant residual disability. In the last decade, novel approaches to the treatment of migraines have been developed based on the theory that extracranial sensory branches of the trigeminal and cervical spinal nerves can be irritated, entrapped, or compressed at points throughout their anatomic course, ultimately leading to the cascade of physiologic events that results in migraine. Botulinum toxin (Botox) injection and surgical decompression of these trigger points have been shown to reduce or eliminate migraines in patients who are incompletely treated by traditional medical management. Despite the recent advances made with Botox, this treatment strategy most commonly results in only temporary migraine prevention. However, the evidence supporting the efficacy and safety of permanent surgical decompression of peripheral trigger points is accumulating rapidly, and the overall success rate of surgery has approached 90%. In addition, an abundance of literature investigating the precise anatomical dissections associated with trigger points has been published concurrently. This article reviews the most up-to-date clinical and anatomic evidence available and seeks to provide a comprehensive, concise resource for the current state of the art in the surgical treatment of migraine headaches.

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confidence: 96%

mentioning

confidence: 99%

A Review of Current Evidence in the Surgical Treatment of Migraine Headaches

Janis¹,

Barker²,

Javadi³

et al. 2014

Plastic and Reconstructive Surgery

Self Cite

107

123

View full text Add to dashboard Cite

show abstract

“…Janis et al in a study of 24 patients found that 9.1 percent had unmasking of previously unidentified auriculotemporal pain. 15 The current literature has not isolated the specific associations between primary and secondary headache sites. This study seeks to quantify the occurrence and determine the predictors of new postoperative migraines at a secondary site.…”

mentioning

confidence: 99%

Emergence of Secondary Trigger Sites after Primary Migraine Surgery

Punjabi

Brown

Guyuron

2016

Plastic &Amp; Reconstructive Surgery

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“…Classically, migraine headaches were described as a central nervous system event, but recent publications have stressed the role of peripheral nerves [4,5]. As the evidence for a peripheral explanation of migraine development continues to increase, so does the evidence for surgical decompression as an effective treatment [6][7][8][9][10][11].…”

Section: Pathophysiologymentioning

confidence: 99%

Surgical Management of Migraine Headaches

Chung¹,

Sanniec²,

Li³

et al. 2017

Current Perspectives on Less-Known Aspects of Headache

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Although migraines are experienced by a significant portion of the population, current medical therapies often fail to completely alleviate the symptoms of many migraine sufferers, leading to significant residual disability. Within the last decade, migraine surgery has arisen as a viable option for patients who have exhausted all other medical treatments. Despite early resistance in the headache care community, it has become more accepted due to an increasing number of studies demonstrating efficacy and safety, and increasing evidence supporting the influence of peripheral nerves in the progression of migraine pathophysiology. Yet, it remains crucial to carefully select appropriate surgical candidates based on the assessment of various factors such as medication use, pain distribution, and any other medical conditions that may contribute to headache. It is equally important to ensure that the patient has a strong relationship with a neurologist for optimal medical management and postoperative medical support. After the appropriate trigger sites are identified, various techniques can be used to decompress the involved larger nerves, avulse the smaller nerves, and address any intranasal pathology that could be causing migraines.

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Validation of the Peripheral Trigger Point Theory of Migraine Headaches: Single-Surgeon Experience Using Botulinum Toxin and Surgical Decompression

Abstract: : Therapeutic, IV.(Figure is included in full-text article.).

Cited by 127 publications

References 49 publications

A Review of Current Evidence in the Surgical Treatment of Migraine Headaches

A Review of Current Evidence in the Surgical Treatment of Migraine Headaches

Emergence of Secondary Trigger Sites after Primary Migraine Surgery

Surgical Management of Migraine Headaches

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