Fronto Temporal Trigeminal Neuralgia

Fronto-Temporal Trigeminal Neuralgia related chronic migraine / headache can be characterized with following findings:

  • Unilateral or bilateral fronto-temporal pain or pressure
  • No specific age range
  • Tender trigeminal nerve branches: zygomatico-temporal, auriculo-temporal, supraorbital, supratrochlear and/or infratrochlear nerves
  • Often positive/temporary response to nerve blocks or Botox
  • May be present with: vision or sinus problems, TMJ, deviated septum, malocclusion
  • Present alone or with other headache or migraine forms.

Migraine headache itself can be defined as an episodic headache lasting 4-72 hours with (any two of): unilateral, throbbing, moderate to severe, worsened by movement) and (any one of): nausea/vomiting, photophobia, phonophobia. It becomes chronic if a headache of any kind lasts > 15 days per month, for at least 3 months. It may present with signs of occipital and/or fronto-temporal neuralgia as well. An aura is a group of symptoms, including vision disturbances, that act as a warning sign that a headache is coming.

The causes of migraines can be very complex and many patients spend years chasing treatments. Very often patients will tell us that few providers were willing to listen to them, and even fewer tried to help them solve cause of their migraines. For many patients who have tried other treatments without success, surgical treatment might be the best option to treat their migraines/fronto-temporal neuralgia neuralgia/chronic headaches.

You should also know:

What is actually done during frontal or temporal peripheral nerve surgery for patients with chronic migraine / headaches?

Frontal: Under general anesthesia, incision in made in the upper eyelids. Incision is placed at the same place as if patient is undergoing cosmetic eyelid surgery, ensuring an ultimately well concealed, hardly visible scar. Gentle anatomical dissection enables visualization of the frontal branches of the trigeminal nerve and its compression points, including the frowning muscles. These points are released, taking pressure of the main nerves and their minor branches. The incision is then closed in anatomical layers. Nerve decompression is done in most patients, preserving forehead sensation. In some patients nerve excision is required due to previous surgery or trauma in that area. In the case of nerve excision, permanent numbness will result in that area. As reported in the literature, I pioneered special implantation technique for these nerves to minimize/eliminate painful neuroma occurrence.

Temporal: Under general anesthesia, an incision in made in the temporal, hair bearing scalp. The temporal nerve is then accessed using an endoscopic approach where a video camera is used to allow direct visualization of anatomical planes and the nerve. Considering that the temporal nerves provide minor sensory coverage of the scalp and that their decompression would require removal of a portion of the temporal muscle; transection, rather than decompression is done. The scalp wound is closed in anatomical layers, leaving a well concealed incision if temporal scalp.

Does this surgery interfere with eye or face movements?

Neither the frontal nor temporal incisions should affect eye closure or facial movements since both the frontal and temporal branches of the trigeminal nerve are exclusively sensory nerves (have no motor function).

Surgery: In-patient or outpatient, its duration, recovery, outcome?

Most, if not all of the above treatments are done on an outpatient basis, unless your pre-existing medical condition would warrant admission. It takes in average 1 – 1.5 hours to perform either frontal nerve neurolysis or temporal nerve excision. There are no special dressings since the incision is hidden in the upper eyelids and temporal scalp. Upper eyelid sutures are removed at about one week, while temporal sutures stay in for three weeks after surgery.

Ambulation is permitted right after the surgery. Activities are limited to light for the first 1-2 weeks. Recovery varies but it usually takes about one-two weeks and can vary depending on several variables (type of professional work done, age, co-morbidities, etc). Similarly, some patients can have immediate headache relief, but most take about 2-3 weeks before experiencing relief, while others may take about 3 months to fully observe benefits of surgery.