Computerized tomographic evaluation of supraorbital notches and foramen in patients with frontal migraine headaches and correlation with clinical symptoms

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Navid Pourtaheri, Bahman Guyuron
PurposeTo correlate the location and size of supraorbital notches (SON) and foramen (SOF) with migraine headache symptoms in a migraine patient population.MethodsA retrospective review was performed on consecutive patients who were candidates for frontal migraine surgery with available pre-operative computed tomography (CT) images of the face/perinasal sinuses. The supraorbital anatomy from CT images was analyzed and correlated with presenting migraine headache symptoms. To assess for anatomic variations associated with migraine headaches, normative anatomic data was obtained through performing a meta-analysis.Results56 patients were included; 95% female, aged 17-80 (mean 47) years. Bilateral SON were present in 58.9% patients, combination of SON/SOF in 25%, and bilateral SOF in 16.1%. SOF mean diameter (1.22 mm) was 45% smaller than SON (2.20 mm, p<0.0001). The mean lateral distance from midline for SOF (2.74 cm) was ~0.5 cm farther than SON (2.25 cm, p<0.0001). Migraine patients with SOF had 178.6% longer mean migraine headache duration (p=0.0020), 9.8% higher intensity (p=0.0052), and 91.4% greater migraine headache index (p=0.0498) compared to those without SOF. Compared to normative patient data, migraine patients are more likely to have SON/SOF (100% vs. 83%, p=0.0047) and have mean SON and SOF diameters that are 34.3-41.5% smaller (p<0.0001).DiscussionNerve compression at SON and especially SOF contributes significantly to migraine headache symptoms and these structures (if present) should be released during frontal migraine surgery. Given the variable presence and location of SON/SOF, analysis of available face/perinasal sinus CT images helps pre-operative planning for foraminotomy and bands release.