Migraine/Headache "Tender Spots" Represent Referred Pain From Nerve Compression/Neuromas and Are Not "Trigger Points"

Area of Science:

• Neurology
• Neurosurgery
• Pain Management

Background:

• Migraine and headache descriptions often lack clarity, leading to diagnostic and therapeutic confusion.
• Current surgical approaches may not fully integrate peripheral nerve principles for migraine treatment.
• The term "trigger point" is frequently used but lacks precise anatomical and pathological definition in this context.

Purpose of the Study:

• To explore the historical origin and clarify the meaning of "trigger point" in relation to migraine/headache.
• To improve the description of clinical examinations for patients experiencing migraines.
• To integrate peripheral nerve concepts into the surgical management of migraines.

Main Methods:

• Historical analysis of the phrase "trigger point" in medical literature.
• Review of neuroanatomical and neurophysiological principles related to cranial and peripheral nerves.
• Correlation of clinical symptoms with underlying peripheral nerve pathology.

Main Results:

• Migraine/headache symptoms are attributed to the stimulation of cranial or peripheral nerves, misinterpreted as meningeal innervation stimulation.
• The phrase "extraction of trigger points" is imprecise and potentially misleading.
• Peripheral nerve pathology, such as nerve compression (neuroma) or irritation, underlies these symptoms.

Conclusions:

• Clinical descriptions of migraine/headache examinations should be standardized using precise neuroanatomical terminology.
• Surgical interventions for migraines should be based on specific peripheral nerve pathology.
• Recommended surgical terms include neurolysis for a compressed nerve or resection for a neuroma, replacing "trigger point extraction".