Anatomical study of zygomaticotemporal nerve: Clinical implications for surgical treatment of migraine headache in Thai population

Abstract

Background : Migraine headache is one of the most common neurovascular disorders that is often inadequately treated by currently available medical therapies. Clinical evidences have shown that the decompression of peripheral nerve trigger points is successful in migraine relief. The nerve responding to the temporal trigger site is the zygomaticotemporal branch of the trigeminal nerve.

Objectives : This cadaveric study of the anatomy of the zygomaticotemporal nerve was undertaken to delineate where this nerve exits the deep temporal fascia in relation to the plane through the superior border of tragus and the zygomaticofrontal suture.

Methods : The temporal region of twenty-two fresh cadaveric hemiheads were dissected through bicoronal incision. Points of measurement where the zygomaticotemporal nerve exits the deep temporal fascia in relation to
the plane through the superior border of tragus and the zygomaticofrontal suture were recorded.

Results : The piercing point of the zygomaticotemporal nerve was located 27.0 3.7 mm from the zygomaticofrontal suture, 3.9 4.7 mm superior to the plane through the superior border of tragus and the zygomaticofrontal suture (HL), and 25.6 3.7 mm lateral to the plane through the zygomaticofrontal suture and perpendicular to HL. No significant difference between the right and left sides was detected.

Conclusions : The nerve responding for the temporal trigger site in migraine headache is the zygomaticotemporal branch of the trigeminal nerve. Surgical decompression or chemodenervation of the surrounding temporalis can
help alleviate the symptoms of migraine headache. Advances in the understanding of detailed anatomical information will enhance the safety and effectiveness of migraine surgery and botulinum toxin A injection
treatment.