Will Temporal Muscle Removal Help My Migraines?
Q: Dr. Eppley, I have complex muscular issue on the left side of my head and face, impacting the temporalis and masseter muscles. I had this issue for around 3 years and it currently has caused a TMJ issue. My temporalis muscle is very painful and causes a lot of twitch and it becomes very painful when goes by the ear down to cheek bones. There is a severe muscle pressure putting stress on my ear and jaw. This makes it difficult to do daily task as causes it causee much stress on muscles around the body. My upper cheek is bigger, hurt sand puts pressure on cheek bone as well. When moving my face, the pain gets stronger. I cannot wear a splint anymore as it pushes muscle more towards the TMJ bone and ear. TMJ was clean and steroid was injected and the steroid has caused more muscle issue in temporalis then was there before. TMJ specialist define muscle root cause but cannot seems to get any treatment answers. I have seen a few TMJ specialists and plastic surgeons. In addition, I have occipital neuralgia. I had migraine surgery where the greater occipital nerves were decompressed and the arauriculotemporal nerves removed. Based on your experience, I have seen you have worked on the temporalis muscle and was wondering if you would be able to resolve my issue. Botox was used with some relief which was a good indication the root of the issue was there. it feels like I have a knot around that area. MRI of head and TMJ did not indicate anything.
A: The critical question is what part of the temporal muscle is involved….anterior, posterior or both. Temporal pain reduction by surgery only works if it exclusively or primarily involves the posterior portion of the muscle. By your description it appears that the anterior portion of the muscle (ear to cheekbone) is the culprit for which muscle reduction/removal can not be done.
Dr. Barry Eppley