Algorithm for Surgical Management of Temporal Migraine Headaches: A 25-Year Retrospective Observational Review

Area of Science:

• Neurology
• Surgical Science

Background:

• Distinguishing zygomaticotemporal nerve (ZTBTN) and auriculotemporal nerve (ATN) as primary temporal migraine trigger sites is challenging.
• A novel algorithm for surgical management of temporal migraines is proposed, based on extensive clinical experience.

Purpose of the Study:

• To develop a clinical tool for differentiating between ATN and ZTBTN as peripheral trigger sites in temporal migraines.
• To evaluate the efficacy and outcomes of surgical deactivation for temporal migraines.

Main Methods:

• A retrospective review of 151 patients undergoing ATN or ZTBTN deactivation for temporal migraines.
• Collection of demographic, clinical, and questionnaire data.
• Statistical analysis using Wilcoxon rank sum test and chi-square/Fischer's exact tests.

Main Results:

• 91% of patients achieved >50% migraine reduction, with 65.7% experiencing complete symptom elimination.
• Specific pain locations indicated successful surgery: anterior non-hairbearing region/frontal sites for ZTBTN, and preauricular pain for ATN.
• Complications were infrequent (4.6%), including neuroma, surgical site infection, and wound dehiscence.

Conclusions:

• The developed algorithm effectively distinguishes between ATN and ZTBTN peripheral trigger sites.
• Surgical intervention based on this algorithm offers a promising management strategy for temporal migraines.
• The study highlights the importance of precise trigger site identification for successful surgical outcomes.