BACKGROUND: The senior author (B.G.) has been able to use the Doppler as a tool for identifying the site of irritation of a nerve by an adjacent artery in different migraine trigger sites. The purpose of this study was to assess the correlation between the most intense pain site identified by the patients, presence of Doppler signal, and the intraoperative finding of an artery in the target site. METHODS: This was a retrospective review of the charts of patients who underwent surgical treatment of migraine headaches involving the auriculotemporal nerve. The target area was identified by asking patients to point to the most intense headache site and most tender area at the time of examination using the index finger tip. This site was marked and Doppler was used to identify the vascular signal. Doppler examination results, intraoperative presence of the superficial temporal artery or its branches, and the involved nerve were recorded and tabulated. RESULTS: A positive Doppler signal over the area of most intense temporal pain, identified by the patient preoperatively, correlated with intraoperative presence of the artery in 100 percent of the patients. Doppler signal was noted on 34 sites and arterectomy was carried out in all 34 sites. CONCLUSION: Doppler signal in the site of most intense pain can predictably document the presence of an artery in the most painful site and lead to precise location of the nerve irritation by a vessel and successful removal of the offending artery.
BACKGROUND: The senior author (B.G.) has been able to use the Doppler as a tool for identifying the site of irritation of a nerve by an adjacent artery in different migraine trigger sites. The purpose of this study was to assess the correlation between the most intense pain site identified by the patients, presence of Doppler signal, and the intraoperative finding of an artery in the target site. METHODS: This was a retrospective review of the charts of patients who underwent surgical treatment of migraine headaches involving the auriculotemporal nerve. The target area was identified by asking patients to point to the most intense headache site and most tender area at the time of examination using the index finger tip. This site was marked and Doppler was used to identify the vascular signal. Doppler examination results, intraoperative presence of the superficial temporal artery or its branches, and the involved nerve were recorded and tabulated. RESULTS: A positive Doppler signal over the area of most intense temporal pain, identified by the patient preoperatively, correlated with intraoperative presence of the artery in 100 percent of the patients. Doppler signal was noted on 34 sites and arterectomy was carried out in all 34 sites. CONCLUSION: Doppler signal in the site of most intense pain can predictably document the presence of an artery in the most painful site and lead to precise location of the nerve irritation by a vessel and successful removal of the offending artery.