Likewise, the 4 procedures that

have been referred to collectively as migraine headache trigger site deactivation surgery may be effective interventions for different 5-Fluoracil in vitro types of head and face pain, but the decision to generalize these procedures as a treatment for a complex disorder such as migraine may have been presumptive. In the case of the intranasal trigger zone, the associated procedure may be useful for the treatment of contact point headache.[21, 22] It is important to note that in a systematic literature review, it was found that most patients with contact points do not have headache or facial pain. In this review, surgical treatment of contact points was found to be inconsistently effective for the treatment of contact point headache.[31] Although it is speculated that relief of the contact point against the nasal wall may lead to direct improvement of the U0126 research buy pain, septoplasty and turbinectomy may also reduce upper airway resistance. This reduction in upper airway resistance may lead to improvement of sleep quality, and poor sleep is a well-known migraine trigger.[4] In the case of the frontal trigger zone, the associated procedure may be useful for the treatment of supraorbital neuralgia. It has been established in the literature that some cases of supraorbital neuralgia may be due to nerve

entrapment, which can be visualized with ultrasound imaging.[24] Subsequent decompression of the nerve has yielded some positive results.[32] By the same logic, future studies may demonstrate that the occipital trigger zone procedure could potentially be useful for the treatment of occipital neuralgia. In the case of the temporal trigger zone, the procedure should be modified to decompress a potentially entrapped nerve rather than performing nerve avulsions, as nerve destructive techniques are more likely to have complications.[8, 9] It is possible that some of the positive results in the surgical literature may have actually been treating one of these other headache

disorders in patients who also have migraines. Some of the mixed results may have treated the additional headache disorder, but the selleck compound surgery exacerbated the subject’s migraines. For example, an occipital procedure may alleviate occipital neuralgia, but the trauma of the surgery may worsen the patient’s migraines. It is clear that more rigorous studies need to be conducted in order to evaluate the potential efficacy of each procedure. Future studies should look at each procedure individually rather than lumping the data together in order to report efficacy for any type of migraine. As such, subjects should not be receiving multiple procedures simultaneously. Presurgical evaluations should include objective testing to look for clear surgical targets, which may be suggestive of a headache disorder that exists in the presence or absence of migraine.