title: Migraine headache trigger site prevalence analysis of 2590 sites in 1010 patients.
abstract: BACKGROUND
  Surgical deactivation of migraine trigger sites offers an alternate treatment option for patients with recalcitrant headaches who are unresponsive to medical therapies or for those who are unable to take medications. The aim of this article is to provide a comprehensive review and a prevalence analysis of 2590 migraine surgery trigger sites in 1010 patients over a 14-year study period.
  
  
  METHODS
  This is a retrospective review of migraine patients who underwent surgical decompression of peripheral nerves. Data from the migraine surgery database maintained by the senior author were reviewed. Preoperative variables included patient demographics and migraine trigger sites, whereas intraoperative variables included specific trigger site deactivation.
  
  
  RESULTS
  Overall, 825 female and 158 male patients underwent the deactivation of 2590 migraine headache trigger sites. Migraine surgery patients had an average of 2.6 trigger sites. A single trigger site was operated in 26.9% of migraine headache patients, whereas 73.1% of the patients had multiple trigger sites. The nasal trigger site (III) was the most prevalent single trigger site affecting 12.3% of patients, and overall 66.9% of patients had this site as a component of their migraine complex. Concurrent occurrence of trigger sites I, II, III, and IV was the most prevalent trigger site combination involving 21.4% of patients.
  
  
  CONCLUSIONS
  This article offers the prevalence information of trigger sites and provides a simple classification for the ease of communication among surgeons and their teams.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, USA.
authors.forename: Nazilla S
authors.initials: NS
authors.lastname: Seyed Forootan
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, USA. Electronic address: Bahman.guyuron@gmail.com.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000293:Adolescent; D002648:Child; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000453:epidemiology* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Migraine headache; Migraine surgery; Pain; Trigger site release