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 Are the Anatomical Migraine Triggers?

There are four anatomical migraine trigger areas: forehead, temples, nose, and neck.

  1. Forehead: Patients with this trigger feel migraines starting above the eye, on the forehead. This trigger involves the supratrochlear (STN) and supraorbital (SON) nerves, which can be irritated by blood vessels, bone, muscle or fascia (lining of the muscles)
  2. Temples: Patients with this trigger feel migraines starting over the temple. This trigger involves the zygomaticotemporal (ZMT) and/or auriculotemporal (ATN) nerves, which can be irritated by blood vessels, muscle or fascia.
  3. Nose: Patients with this trigger feel migraines starting behind the eye, and may also experience congestion, runny nose and other cold symptoms with their migraines. This trigger is associated with various small nerve branches of the trigeminal nerve (TGN), which can be irritated by the bone, cartilage or mucosa (lining) of the nose.
  4. Neck: Patients with this trigger feel migraines starting over their neck. This trigger is associated with the greater occipital nerve (GON) but also may involve two other nerves: the lesser occipital nerve (LON) and third occipital nerves (TON). All of these nerves can be irritated by blood vessels, muscle or fascia.

The aforementioned migraine trigger points – with the exception of the nose – have been shown to respond to Botox injections. Migraine decompression surgery is also a treatment option for all trigger sites.

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.

Find out if you are a candidate for migraine surgery.

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