What are Migraine Trigger Sites?
Finding a qualified physician who can determine your migraine trigger sites is the first step to finding out if surgical treatment is right for you. Many who endure migraines are unable to find relief from the conventional practices and continue to suffer. This specialized treatment has brought relief to individuals by focusing specifically on the offending nerve(s).
Every person who suffers from migraines experiences them differently and may have a combination of active trigger sites. In a consultation, Dr. Guyuron, Dr. Ansari, and Dr. Totonchi can determine which sites may be relieved through migraine surgery. Although there are several less common migraine trigger sites, the four main points are located in the frontal/forehead area, the temporal area around the temples, the occipital area at the back of the head, and the nasal area extending behind the eyes.
4 Main Migraine Trigger Sites and Treatments
There are several different trigger sites that patients should be aware of.
Frontal Trigger Site
The nerves associated with this trigger point are called supraorbital and supratrochlear nerves, and are situated just above the eyebrows. These nerves pass through a bony notch or tunnel along with the vessels and then through frowning muscles, all of which could cause nerve irritation. For trigger points in the forehead area, surgery can be done by open technique or endoscopically. These procedures are done using several tiny incisions in the hairline, or a direct upper eyelid incision. The chosen incision site for this trigger site will determine the length of surgery, usually one to two hours.
Temporal Trigger Site
The temporal headaches occur when an intricate branch of the trigeminal nerve is irritated by adjacent muscles or vessels and is often seen in people who grind their teeth. As the name suggests, the above-referenced branch, known as the zygomaticotemporal, is located in the temporal (or temple) area. As with the frontal trigger site procedure, this technique is also done via endoscopy, where an incision is made in the upper eyelid or along the hairline. The procedure can last 30 minutes to one hour.
Occipital Trigger Site
The greater occipital nerve supplies sensation to the back of the head. Several structures within that area can cause compression of this nerve. A migraine surgeon is capable of determining what is irritating the nerve and eliminate it. This technique involves making an incision in the back of the head and releasing all of the structures causing nerve irritation.
Nose Trigger Site
Nose mucosa is very rich with sensory nerves, and any irritation due to contact point between septum (partition in the middle of the nose) and turbinate or air pockets within the turbinate can cause headaches. The turbinate(s), also known as concha (pleural conchae), are sausage-shaped structures made of thin bone covered by spongy mucous membranes in the side walls of the nose.
Patients will often experience their migraines behind the eyes, usually in the morning upon awakening (wake-up migraine). Weather and barometric pressures change are often major triggers for these patients. Small branches of the trigeminal nerve system that runs throughout the nasal cavity can become irritated when compressed within these structures. An air pocket in the turbinate, called concha bullosa, can sometimes develop and act as a trigger point. Depending on the location of the nerve irritation, which usually needs a CT scan to determine, the type of procedure may vary.
Surgery on this migraine site can take about one hour or longer, depending on the chosen technique. Improvement in breathing may occur as a side benefit to the procedure.
Other Trigger Sites
Less common trigger sites include peripheral trigger site, lesser occipital nerve trigger site located in the back of the head closer to the ears, and the auriculotemporal trigger sites located in the temporal region just along or within the hairline.
- Auriculotemporal trigger site: the auriculotemporal nerve lies in the temple region along or within the hairline, where the nerves can be irritated by the temporal artery.
- Peripheral trigger sites: In some migraine sufferers, the terminal branches of the nerves in the cranial area can be disturbed by a blood vessel or a band of soft tissue.
- Lesser occipital nerve site: This nerve is at the back of the head and can cause pain if irritated or compressed. The headaches are felt in the scalp closer to the ear.
One of our experienced physicians will assist you in determining which trigger site(s) might be causing your headache and develop an appropriate treatment plan.
Schedule a Consultation Regarding Migraine Trigger Sites in San Diego
If conventional treatments such as medication and lifestyle changes have not offered relief from your suffering, you might be a migraine surgery candidate at our San Diego or Cleveland facilities, in person or virtual visit options are available.
Postsurgical downtime is minimal, with some patients returning to work the next day or even the same day of the procedure.