Does Vascular Decompression Help Temporal Migraines?
Q: Dr. Eppley, I read your explanation of the temporal migraine with a vascular component rather than a muscular one caught my attention. Are there any research into the effectiveness of this kind of surgery or do you have a personal experience with it´s alleviation of migraines? Do you have a personal experience of local anesthetic as a diagnostic test? I am currently undergoing Botox injections into triggers points to determine how best to help my migraines.
A: I wrote that migraine surgery blog based on my clinical experience in doing it. While temporal migraines can usually be relieved by avulsion of the zygomaticotemporal nerve just outside the lateral orbit, it is not always completely effective. That is why I often will ligate/decompress the anterior branch of the superficial temporal artery as it courses along with the auriculotemporal nerve in the scalp portion of the temporal region. Through a single vertical temporal incision both procedures can be done simultaneously. Since there is no harm is eliminating this vascular element, it is often a part of my temporal migraine surgical approach. The use of local anesthetics would not be effective in determing if there is a vascular component to your temporal migraines. Like Botox, local anesthetics only provide insight into a muscular compression source of a migraine.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.