Efficacy of Surgical Treatment of Migraine Headaches Involving the Auriculotemporal Nerve (Site V).

Background: This study reports the surgical technique and efficacy of treatment for the less commonly studied auriculotemporal nerve (site V). The aim was to evaluate symptom relief and differences in migraine headache parameters (i.e., intensity, duration, and migraine-free days) after site V surgery.

Methods: Patients undergoing site V surgery for auriculotemporal nerve-triggered migraine headaches were analyzed. Charts were reviewed retrospectively for age, sex, dates of surgery and follow-up, preoperative migraine data, types of surgery, and laterality. Postoperatively, patients completed a migraine headache questionnaire by means of office visit, phone, e-mail, or video conference.

Results: Forty-three patients were included in the study (36 women; median age, 50 years; interquartile range, 40 to 57 years). The majority of patients underwent bilateral surgery (n = 36) and reported site-specific relief (n = 34). The average follow-up was 17.2 months. The number of migraine-free days (per month) increased from 12.6 days before surgery to 25.1 days after surgery (median increase, 12.6 days; p < 0.005). Median migraine intensity scores decreased from 8.3 to 3.2 after surgery (median decrease, 5.1; p < 0.005) on 10-point severity scale. Migraine duration decreased from 1.2 hours/day to 0.5 hour/day after surgery (median decrease, 0.7 hour/day, p < 0.005). The median difference in migraine duration was the only value found not to be statistically significant, defined as p < 0.005. On both univariate and multivariate analyses, patient-reported site relief was significantly associated with decreased migraine intensity.

Conclusions: Surgery for auriculotemporal nerve-triggered migraine headaches improves migraine headache parameters. This study is the first to examine surgical efficacy of this less commonly studied trigger site.

Clinical Question/level Of Evidence: Therapeutic, IV.