Migraine Triggers

Despite the cause of the migraine pain, there are known anatomical and environmental factors that can “trigger” migraine headaches. Common environmental triggers include foods and food additives, medications, environmental changes, hormonal changes and stress. Most migraine sufferers have anatomical specific triggers that they recognize cause their particular headaches to occur.

Migraine Trigger Points

Although environmental factors are common triggers for migraine sufferers, there is a separate category of “migraine triggers” that are anatomical: nerve triggers.  These are nerves of sensation around the face and neck that can send faulty signals to the brain, causing a domino effect that ends in a migraine.
Dr. Jonathan Cabin of The Migraine Institute helps patients achieve long-lasting migraine relief by finding and treating migraine triggers. As a board-certified head and neck surgeon with dual-subspecialty training in facial plastic and reconstructive surgery, Dr. Cabin takes a comprehensive and personalized approach to migraines. Dr. Cabin helps patients determine the best course of action to reduce or eliminate migraines via nerve trigger treatments.

What Triggers a Migraine?

A migraine takes place inside the brain, but it actually begins outside the brain. During a migraine attack, an anatomical trigger delivers a faulty signal to the brain. This ultimately results in migraine pain inside the brain.

There are four anatomical triggers for a migraine. These are:

  1. Forehead: Causes an individual to experience migraine pain from above the eye or on the forehead, either on one or both sides. Forehead migraines occur when the supratrochlear or supraorbital nerves are irritated by bone, blood vessels, muscle or fascia (lining of muscles).
  2. Temples: Causes an individual to experience migraine pain from the temples area, either on one or both sides. Temples migraines occur due to irritation of the zygomaticotemporal or auriculotemporal nerves; this irritation may be caused by blood vessels, muscle or fascia.
  3. Nose: Causes an individual to experience migraine pain from behind the eye and affects one or both sides of the nose. Additionally, nose migraines may cause congestion, a runny nose and other cold symptoms. Many nerve branches may be involved in nose migraines, and these nerves can be irritated by bone or cartilage or the mucosa (lining) of the nose.
  4. Neck: Causes an individual to experience migraine pain from the back of the neck that impacts one or both sides of the neck. Neck migraines occur due to irritation of the greater occipital nerve, lesser occipital nerve or third occipital nerve by blood vessels, muscle or fascia.

Is It Possible to Treat Migraine Triggers?

There is no one-size-fits-all treatment to address the anatomical triggers of migraines. Following an initial migraine diagnosis from a doctor, individuals often receive preventative and pain-relieving medications to treat migraine pain. Preventative medications are designed to help individuals alleviate migraine pain over an extended period of time, while pain-relieving medications act quickly to treat migraine pain as it occurs.

Although migraine medications may be prescribed, these treatments sometimes fail to help patients achieve long-term migraine pain relief. In some instances, migraine medications are ineffective and do not help patients minimize migraine pain. Or, in other cases, migraine medications cause intolerable side effects like nausea, vomiting, dizziness and fatigue.

Dr. Cabin of The Migraine Institute treats the four anatomical triggers of migraines. He is happy to help individuals who have received a chronic migraine diagnosis and find that their current migraine medications are ineffective or cause unwanted side effects.

To treat the anatomical triggers of migraines, Dr. Cabin may recommend Botox® injections or minimally invasive surgery. Botox® is an FDA-approved treatment that can be administered across a migraine patient’s head and neck. It can be administered every two to four months and has been shown to help migraine patients prevent an average of eight to nine migraine days per month. Comparatively, migraine surgery is available to permanently remove the faulty nerve signals that causes migraines. Dr. Cabin uses advanced migraine decompression surgery techniques to address a patient’s migraine triggers. He also customizes each surgical procedure to help a patient achieve the best-possible results.

Dr. Cabin uses a comprehensive migraine consultation process to help a patient determine if Botox® or minimally invasive surgery is a viable option. He allocates significant time and resources to perform a patient assessment. That way, Dr. Cabin can help a patient find the best way to alleviate migraine pain both now and in the future.

How Are Anatomical Migraine Trigger Sites Diagnosed?

Dr. Cabin will perform comprehensive testing to determine whether a patient is a candidate for migraine decompression surgery, and which anatomical trigger sites to treat. However, he will complete a patient assessment only after an individual has received a chronic migraine diagnosis from a neurologist and finds that current medications are not working and/or cause intolerable side effects.

It may take several weeks or months to determine a patient’s anatomical migraine trigger sites. During this time, Dr. Cabin mayA may perform or prescribe one or more of the following tests to verify an anatomical migraine trigger site:

  • Nerve block injection(s)
  • Botox injection(s)
  • Doppler ultrasound
  • CT scan
  • Nasal spray
  • Examination by other specialists

What Are The Treatment Options For Anatomical Migraine Triggers?

Botox has been shown to help treat three of the anatomical migraine triggers. It works by relaxing the muscle around the nerves, and potentially acts on the nerves themselves. Botox is long-lasting but temporary, requiring repeat injections every two to four months. Unlike Botox injections elsewhere, Dr. Cabin uses the smallest needles available and, combined with his unique injection protocol, are nearly pain free.

Depending on the cause of nerve irritation, migraine surgery can be an excellent option in patients who may or may not have previously received Botox injections. Migraine surgery is a minimally invasive procedure that helps eliminate the faulty signals from the trigger nerves that can cause migraines. Migraine surgery is an outpatient procedure that typically lasts between one and five hours, depending on the number of trigger nerves requiring treatment. A patient can often return home the same day as surgery.

Prior to migraine surgery, Dr. Cabin will use an in-depth patient evaluation and anatomical migraine trigger point confirmation techniques to determine if an individual is an appropriate candidate for the procedure. He will then develop a customized surgical plan for the patient, which may include up to four trigger sites. After surgery, over 90% of patients notice a significant reduction in the frequency, duration and/or intensity of migraines, and nearly 50% find themselves migraine-free within a few months of treatment.

To schedule a consultation with Dr. Cabin, please contact us at 310.461.0303 or fill out our online form.

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