Anatomy of the supratrochlear nerve: Implications for the surgical treatment of migraine headaches

Jeffrey E. Janis, Daniel A. Hatef, Robert Hagan, Timothy Schaub, Jerome H. Liu, Hema Thakar, Kelly M. Bolden, Justin B. Heller, T. Jonathan Kurkjian

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Migraine headaches have been linked to compression, irritation, or entrapment of peripheral nerves in the head and neck at muscular, fascial, and vascular sites. The frontal region is a trigger for many patients' symptoms, and the possibility for compression of the supratrochlear nerve by the corrugator muscle has been indirectly implied. To further delineate their relationship, a fresh tissue anatomical study was designed. Methods: Dissection of the brow region was undertaken in 25 fresh cadaveric heads. The corrugator muscle was identified on both sides, and its relationship with the supratrochlear nerve was investigated. Results: The supratrochlear nerve was found in all 50 hemifaces. Three potential points of compression were uncovered in this investigation: the nerve entrance into the brow through the frontal notch or foramen, the entrance of the nerve into the corrugator muscle, and the exit of the nerve from the corrugator muscle. The nerve generally bifurcates within the retro- orbicularis oculi fat pad, and these branches enter into one of four relationships with the corrugator muscle: both branches enter the muscle, one branch enters the muscle and one remains deep, both branches remain deep, and the branches further branch into ever smaller filaments that cannot be identified cranially. Conclusions: Some patients are nonresponders to migraine decompression techniques that address the supraorbital nerve. The supratrochlear nerve may be compressed in these patients.Astandard corrugator resection that comes more medially within 1.8 cm of the midline may be beneficial. The morphology of the frontal notch/foramen must be examined and addressed if necessary.

Original languageEnglish (US)
Pages (from-to)743-750
Number of pages8
JournalPlastic and Reconstructive Surgery
Volume131
Issue number4
DOIs
StatePublished - Apr 2013

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Migraine Disorders
Anatomy
Muscles
Therapeutics
Head
Decompression
Peripheral Nerves
Blood Vessels
Adipose Tissue
Dissection
Neck

ASJC Scopus subject areas

  • Surgery

Cite this

Janis, J. E., Hatef, D. A., Hagan, R., Schaub, T., Liu, J. H., Thakar, H., ... Kurkjian, T. J. (2013). Anatomy of the supratrochlear nerve: Implications for the surgical treatment of migraine headaches. Plastic and Reconstructive Surgery, 131(4), 743-750. https://doi.org/10.1097/PRS.0b013e3182818b0c

Anatomy of the supratrochlear nerve : Implications for the surgical treatment of migraine headaches. / Janis, Jeffrey E.; Hatef, Daniel A.; Hagan, Robert; Schaub, Timothy; Liu, Jerome H.; Thakar, Hema; Bolden, Kelly M.; Heller, Justin B.; Kurkjian, T. Jonathan.

In: Plastic and Reconstructive Surgery, Vol. 131, No. 4, 04.2013, p. 743-750.

Research output: Contribution to journalArticle

Janis, JE, Hatef, DA, Hagan, R, Schaub, T, Liu, JH, Thakar, H, Bolden, KM, Heller, JB & Kurkjian, TJ 2013, 'Anatomy of the supratrochlear nerve: Implications for the surgical treatment of migraine headaches', Plastic and Reconstructive Surgery, vol. 131, no. 4, pp. 743-750. https://doi.org/10.1097/PRS.0b013e3182818b0c
Janis, Jeffrey E. ; Hatef, Daniel A. ; Hagan, Robert ; Schaub, Timothy ; Liu, Jerome H. ; Thakar, Hema ; Bolden, Kelly M. ; Heller, Justin B. ; Kurkjian, T. Jonathan. / Anatomy of the supratrochlear nerve : Implications for the surgical treatment of migraine headaches. In: Plastic and Reconstructive Surgery. 2013 ; Vol. 131, No. 4. pp. 743-750.
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AU - Schaub, Timothy

AU - Liu, Jerome H.

AU - Thakar, Hema

AU - Bolden, Kelly M.

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AU - Kurkjian, T. Jonathan

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N2 - Background: Migraine headaches have been linked to compression, irritation, or entrapment of peripheral nerves in the head and neck at muscular, fascial, and vascular sites. The frontal region is a trigger for many patients' symptoms, and the possibility for compression of the supratrochlear nerve by the corrugator muscle has been indirectly implied. To further delineate their relationship, a fresh tissue anatomical study was designed. Methods: Dissection of the brow region was undertaken in 25 fresh cadaveric heads. The corrugator muscle was identified on both sides, and its relationship with the supratrochlear nerve was investigated. Results: The supratrochlear nerve was found in all 50 hemifaces. Three potential points of compression were uncovered in this investigation: the nerve entrance into the brow through the frontal notch or foramen, the entrance of the nerve into the corrugator muscle, and the exit of the nerve from the corrugator muscle. The nerve generally bifurcates within the retro- orbicularis oculi fat pad, and these branches enter into one of four relationships with the corrugator muscle: both branches enter the muscle, one branch enters the muscle and one remains deep, both branches remain deep, and the branches further branch into ever smaller filaments that cannot be identified cranially. Conclusions: Some patients are nonresponders to migraine decompression techniques that address the supraorbital nerve. The supratrochlear nerve may be compressed in these patients.Astandard corrugator resection that comes more medially within 1.8 cm of the midline may be beneficial. The morphology of the frontal notch/foramen must be examined and addressed if necessary.

AB - Background: Migraine headaches have been linked to compression, irritation, or entrapment of peripheral nerves in the head and neck at muscular, fascial, and vascular sites. The frontal region is a trigger for many patients' symptoms, and the possibility for compression of the supratrochlear nerve by the corrugator muscle has been indirectly implied. To further delineate their relationship, a fresh tissue anatomical study was designed. Methods: Dissection of the brow region was undertaken in 25 fresh cadaveric heads. The corrugator muscle was identified on both sides, and its relationship with the supratrochlear nerve was investigated. Results: The supratrochlear nerve was found in all 50 hemifaces. Three potential points of compression were uncovered in this investigation: the nerve entrance into the brow through the frontal notch or foramen, the entrance of the nerve into the corrugator muscle, and the exit of the nerve from the corrugator muscle. The nerve generally bifurcates within the retro- orbicularis oculi fat pad, and these branches enter into one of four relationships with the corrugator muscle: both branches enter the muscle, one branch enters the muscle and one remains deep, both branches remain deep, and the branches further branch into ever smaller filaments that cannot be identified cranially. Conclusions: Some patients are nonresponders to migraine decompression techniques that address the supraorbital nerve. The supratrochlear nerve may be compressed in these patients.Astandard corrugator resection that comes more medially within 1.8 cm of the midline may be beneficial. The morphology of the frontal notch/foramen must be examined and addressed if necessary.

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