Topographic Relationship between the Supratrochlear Nerve and Corrugator Supercilii Muscle--Can This Anatomical Knowledge Improve the Response to Botulinum Toxin Injections in Chronic Migraine?

Hyung-Jin Lee,Sung-Yoon Won,Kwang-Seok Choi,Hee-Jin Kim,Tanvaa Tansatit,Seong-Taek Kim,Kyung-Seok Hu,Prawit Apinuntrum

doi:10.3390/toxins7072629

Hyung-Jin Lee, Sung-Yoon Won + Show 6 more

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https://doi.org/10.3390/toxins7072629

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Abstract

Chronic migraine has been related to the entrapment of the supratrochlear nerve within the corrugator supercilii muscle. Recently, research has shown that people who have undergone botulinum neurotoxin A injection in frontal regions reported disappearance or alleviation of their migraines. There have been numerous anatomical studies conducted on Caucasians revealing possible anatomical problems leading to migraine; on the other hand, relatively few anatomical studies have been conducted on Asians. Thus, the aim of the present study was to determine the topographic relationship between the supratrochlear nerve and corrugator supercilii muscle in the forehead that may be the cause of migraine. Fifty-eight hemifaces from Korean and Thai cadavers were used for this study. The supratrochlear nerve entered the corrugator supercilii muscle in every case. Type I, in which the supratrochlear nerve emerged separately from the supraorbital nerve at the medial one-third portion of the orbit, was observed in 69% (40/58) of cases. Type II, in which the supratrochlear nerve emerged from the orbit at the same location as the supraorbital nerve, was observed in 31% (18/58) of cases.

Highlights

The supratrochlear nerve (STN) and supraorbital nerve (SON) constitute the terminal branch of the frontal nerve, which is a major branch of the ophthalmic nerve
The emergence patterns of the STN were divided into two main types: I and II
Type I, in which the STN emerged separately at the medial one-third portion of the orbit, was observed in 40 cases (69%). These cases could be further divided into type Ia, in which the STN entered the corrugator supercilii muscle (CSM) as a single nerve branch, and type Ib, in which the STN bifurcated prior to entering the CSM

Summary

Introduction

The supratrochlear nerve (STN) and supraorbital nerve (SON) constitute the terminal branch of the frontal nerve, which is a major branch of the ophthalmic nerve. BTX-A is routinely administered as a treatment for chronic migraine in the frontal region [9,13,15]. The trigger point is generally targeted as the injection site for the BTX-A treatment to relieve the associated pain [16,17]. Chronic migraine may occur as a result of entrapment of the STN by the CSM; the STN could be compressed by hyperactivity of the CSM [5,9]. Since the STN is thought to be a trigger point for headache in the frontal region [18,19], BTX-A injection is broadly performed in the supraorbital area. There has been little research to determine the most effective BTX-A injection point based on detailed knowledge of the anatomical structure of the frontal area

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