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

Distinguishing between the zygomaticotemporal nerve (ZTBTN) and auriculotemporal nerve (ATN) as the principal trigger site for temporal migraines remains challenging. We provide an algorithm of surgical management of temporal migraines based on the senior author's 25-year experience.

Retrospective review of patients who underwent ATN or ZTBTN deactivation for temporal migraine headaches was performed. Demographic, clinicalm and questionnaire data were collected. Wilcoxon rank sum test for continuous variables and chi-square or Fischer's exact tests for categorical variables were used.

Analysis of 151 patients (ATN: n = 114, ZTBTN: n = 74) was performed, with 91% (n = 133) of patients experiencing greater than 50% migraine reduction and 65.7% (n = 99) with complete symptom elimination. Indications for successful surgery are pain at the non-hairbearing region anterior to the hairline (p < 0.01) and frontal trigger sites (p = 0.01) for the ZTBTN cohort, and preoperative preauricular pain (p < 0.01) in the ATN cohort. Sixty one patients (40.3%) who did not have complete elimination of migraine symptoms underwent subsequent reoperations to the same (n = 39, 25.8%) or different temporal trigger site (n = 22, 14.6%). Complications occurred in 4.6% of patients, including neuroma (n = 4, 2.6%), surgical site infection (n = 2, 1.3%), and wound dehiscence (n = 1, 0.7%).

This algorithm provides a straightforward clinical tool to distinguish between the ATN and ZTBTN peripheral trigger sites in the surgical management of temporal migraines.