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Morphometric Evaluation of the Corrugator Migraine Trigger Point
Jessica Hsu, MD, PhD1, Ashley Stasiak, MD2, Eric Adelman, MD1, Jeffrey Janis, MD3, Paul Cederna, MD1, Theodore Kung, MD1.
1University of Michigan, Ann Arbor, MI, USA, 2University of Southern California, Los Angeles, CA, USA, 3Ohio State University, Columbus, OH, USA.

Purpose:
Migraine headaches are often attributed to specific peripheral craniofacial trigger points. Some have postulated that hypertrophy of the corrugator muscles causes compression of the supraorbital and supratrochlear nerves and results in migraine headaches. This study uses morphometric evaluation to determine if anatomic differences exist at the corrugator trigger site between migraine and control patients.
Methods: A retrospective investigation identified patients with and without migraine headache. Each patient underwent a computed tomography (CT) scan for inclusion in the study. Using a three-dimensional image processing program (Vitrea Core), morphometric evaluation of the corrugator muscles was performed in a randomized and blinded fashion on 90 migraine headache and 90 control patients. Measurements were also normalized to zygoma-to-zygoma distance to account for variations in skull size. When sidedness of the symptomatic corrugator trigger was documented, further subgroup analysis was conducted. Statistical comparisons were performed using t-tests.
Results: Among migraine patients, the mean corrugator volume was 0.97±0.25cm3 compared to 1.12±0.30cm3 in controls (p=0.0003) whereas the mean maximum thickness was 5.35±0.89mm compared to 5.61±0.93mm in controls (p=0.054). In subgroup analysis of 28 patients, mean anatomic measurements from the symptomatic side were compared to those of the mean contralateral asymptomatic side. The mean symptomatic corrugator volume was 0.95±0.18cm3 versus 0.98±0.15cm3 (p=0.60). The mean symptomatic corrugator thickness was 5.25±0.87mm versus 5.40±1.01mm (p=0.54).
Conclusions: Muscle hypertrophy in itself does not play a major role in triggering migraine headaches. Instead, factors such as muscle hyperactivity or peripheral nerve sensitization may be more causative.


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