“Morphometric Evaluation of the Frontal Migraine Trigger Site”

Background: Migraine headache has been attributed to specific craniofacial peripheral nerve trigger sites. Some have postulated that hypertrophy of the corrugator muscles causes compression of the supraorbital and supratrochlear nerves resulting in migraine headache. This study uses morphometric evaluation to determine if corrugator anatomy differs between patients with migraine headache and control subjects. Methods: A retrospective review identified patients with and without migraine headache who had a recent computed tomography (CT) scan. Morphometric evaluation of the corrugator supercilii muscles was performed in a randomized and blinded fashion on 63 migraine headache and 63 gender-matched control patients using a three-dimensional image-processing program. These images were analyzed to determine if corrugator size differed between migraine and control patients. Results: There was no difference in mean corrugator volume or thickness between migraine and control patients. The mean corrugator volume was 1.01 ± 0.26 cm3 compared to 1.06 ± 0.27 cm3 in control patients (p = 0.258) and the mean maximum thickness was 5.36 ± 0.86 mm in migraine patients compared to 5.50 ± 0.91 mm in controls (p = 0.359). Similarly, subgroup analysis of 38 patients with frontal migraine and 38 control subjects demonstrated no difference in corrugator size. Further subgroup analysis of nine patients with unilateral frontal migraine showed no difference in corrugator size between the symptomatic side compared to the contralateral side. Conclusion: Muscle hypertrophy itself does not play a major role in triggering migraine headache. Instead, factors such as muscle hyperactivity or peripheral nerve sensitization may be more causative. Financial Disclosure Statement: The authors have nothing to disclose. No funding was received for this article. Presented at: American Society for Peripheral Nerve 2016 in Scottsdale, Arizona and Plastic Surgery Research Council 2016 in New York City, New York. ACKNOWLEDGMENTS:The authors thank Eric Wizauer for his time and assistance with VitreaCore and the University of Michigan Consulting for Statistics, Computing, and Analytics Research as well as Niki Matusko for their guidance with statistical analysis. Corresponding author: Theodore A Kung, MD, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, Michigan 48109 USA, thekung@med.umich.edu ©2018American Society of Plastic Surgeons