A new study shows that two different surgical techniques are effective against migraines, but since they combat the same mechanism as nonsurgical TMJ treatment, you should consider nonsurgical treatment first.
How a Small Nerve Branch Leads to Big Headaches
Migraines aren’t really one condition. They’re lots of different conditions caused by many different factors that all end up with the same effect: painful, long-lasting headaches.
One potential cause of migraines is overstimulation of the trigeminal nerve. The trigeminal nerve brings a lot of data to the brain, and when it gets overloaded, it can cause trouble. One of things that can happen is the release of vasodilators, which expand blood vessels in the brain. These expanded blood vessels put pressure on the brain because the skull doesn’t allow for expansion, and this leads to pain.
In this study, researchers were looking at one particular part of the trigeminal nerve, called the zygomaticotemporal branch of the trigeminal nerve (ZTBTN). This nerve branches out from the maxillary (upper jaw) branch of the trigeminal nerve, follows a groove in the cheekbone (zygomatic bone), and ends in a depression in the skull called the temporal fossa. The temporal fossa is there to allow room for the temporal muscle, one of the primary muscles of mastication (chewing).
Cutting to Relieve Pain
Plastic surgeons approached this problem as one that can be solved by cutting. To relieve migraines in this study, plastic surgeons took two different approaches to relieving pressure on the ZTBTN. They either removed a blood vessel and membranes that put pressure on the nerve, or they just removed the nerve itself.
Patients received both treatments, one on each side of their head, though which side received which treatment was randomized.
Equally Successful Treatments
The study shows that both of the treatments worked well. In fact, 90% of patients saw at least a 50% reduction in the number and intensity of migraines on both sides of their head. The amount of reduction was not statistically different between the two treatments.
Patients reported that reducing pressure on the nerve reduced the number of migraines from 14.6 to 2.2 per month. Removing the nerve caused the number of migraines to drop from 14.2 to 1.9 per month. Severity of migraines decreased from 7.0 to 2.9 when pressure was reduced and from 6.8 to 2.6 when the nerve was removed.
Reducing Pressure without Surgery
These are great results that show this surgical approach can effectively treat migraines. However, there may be a better way to reduce pressure without the need for surgery.
When you have TMJ, your muscles of mastication can become overactive. They may receive excess stimuli and try to find a comfortable position, even though the current configuration of teeth and bones doesn’t let them find it. This can result in these muscles of mastication putting pressure on several areas of the trigeminal nerve, including the ZTBTN. TMJ treatment can reduce muscle overactivity, which can significantly reduce migraines in strength and frequency.