In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)

Abstract

Therapeutic, IV.

Patient Pain Sketches Can Predict Surgical Outcomes in Trigger-Site Deactivation Surgery for Headaches

“…Furthermore, drawings are inexpensive, readily available, and easy to interpret by practitioners with limited experience. They are a useful supplement to, but not a substitute for, the trigger-site detection algorithm pioneered by Guyuron et al 4 – 6 , 13 , 14 This algorithm varies per site, but consists of identification of the headache origin with one finger, presence of a constellation of headache symptoms, identification of arterial Doppler signal, and nerve block/chemodenervation of the trigger site. The authors have developed and published the PAINS diagram (Fig.…”

“…The authors have developed and published the PAINS diagram (Fig. 5 ) 4 – 30 to summarize the Guyuron trigger-site algorithm and amend the preoperative algorithm to include the use of pain sketches to identify trigger sites. 14 , 15 …”

“…P , Pain point identifiable with one finger. 4 – 6 , 14 , 16 Greater occipital nerve ( GON ): 3 cm caudal to the occipital protuberance and 1.5 cm lateral to the midline. 12 , 17 – 19 Lesser occipital nerve ( LON ): variable, lateral and caudal to the greater occipital nerve.…”

“… 11 A , Appropriate symptoms. 4 – 6 , 14 , 16 I , Injectables improve pain. 4 – 6 , 14 , 16 Blue points indicate injection sites.…”

“… 1 – 3 Successful surgery heavily relies on selection of appropriate candidates and identification of all trigger sites. 4 – 6 Several different screening tools including headache history, physical examination, validated questionnaires, and imaging studies are available to aid in choosing suitable candidates. However, verbal communication with the patient and written information in the form of questionnaires often do not accurately reflect complex pain patterns.…”