Posted on November 5, 2015
This is a continuation of my blog on Detection of Migraine Trigger sites. We see many of these patients in clinic, as Botox is well known to help with some migraines. For some Botox does not work. A key is identifying WHERE your trigger site is.
How do you identify the trigger site?
- Ask the patient to tell you where their pain originates from. They can usually pinpoint it with a single finger.
- Clinical history can help. The nerve branch will correlate with other areas. (if along the superficial temporal artery, the main branch, they may have pain close to the helix of the ear. If it is the anterior branch, they will point to the anterior hairline.)
- Look at the constellation of symptoms from my prior blog. This helps localize the site.
- If in the temple, they can use Doppler signal to see the artery as it crosses and irritates the nerve
- Nerve block can be done using numbing medication during the time of an attack. 2cc is injected with a 30 gauge needle. If the pain is relieved after 5-10 minutes, it has identified the trigger site.
- Botox injection. This is helpful for nerve compression that is muscular. For the nonmuscular compression and irritation (from fascial bands or blood vessels) this will not work. If it helps some, then there is another trigger.
- 25 units per side for occipital trigger site, near the emergence of the nerve
- frontal trigger site 12.5 units per site, into glabella
- temporal 25 units per side, injecting into the temporalis muscle in a fan shape starting near the point of emergence of the nerve. They found 50% of the patients the nerve does not run through the muscle.
- CT scan
- Helpful for rhinogenic (near the nose/sinus) migraine headaches.
- You are looking for contact points between the septum, turbinates, concha bullosa, haller’s cell, and inflammation of the sinus lining.
- These issues within the nose are then treated surgically.
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.