Extra-cranial Science

Three areas of the anatomy play a major role in migraine, cluster and hemiplegic migraine; arteries, cranial muscles and the trigeminal nerve. Click on any of these three areas to learn more about their role in migraine and how extra-cranial procedures can assist.


arteries and veins of the faceThe superficial arteries of the face and scalp which are most frequently associated with migraine include the superficial temporal artery, a major artery of the head, the occipital artery which supplies blood to the back of the scalp, sternomastoid muscles and muscles deep in the back and neck, as well as the posterior auricular artery which supplies blood to the scalp behind the ear and to the ear itself. In lay person’s terms, a migraine attack occurs when these superficial arteries dilate (enlarge) and cause pain.

Extra-cranial procedures work in those patients with extra-cranial vascular pain. When the relevant arteries are compressed it reduces or completely eliminates the pain of migraine or cluster headache. These muscles can then be cauterized, surgically ligated or deactivated and this provides permanent relief not only from the pain but from the associated symptoms such as the aura, light sensitivity, sensitivity to sound, nausea, vomiting and hemiplegia.


Cranial Muscles

Mandibular muscles

Clinical findings indicate a strong relationship between migraine headache and neck pain, or neck-muscle stiffness or tenderness. The muscles most often associated with migraine are the masseter muscle, responsible for the chewing motion, the sternocleidomastoid, responsible for rotation of the head and flexion of the neck and the temporalis muscle which covers the temple and also works when chewing.

Extra-cranial procedures to address muscular pain in migraine include an intra-oral device which encourages the jaw to assume its resting position, as well as the injection of botulinum toxin (Botox) into the muscle trigger sites to relax overactive muscles.


Trigeminal Nerve


The trigeminal nerve transports impulses to and from the face. Research shows that when the peripheral branches of the trigeminal nerve become irritated and release neurotoxins, the result can be migraine headaches.

For this reason work on the trigeminal nerve has become an important part of extra-cranial technologies. Dr Guyuron, an American plastic surgeon has pioneered a procedure involving the removal of specific sections of nerves, connective tissue and muscle around areas of the inflamed trigeminal nerve. Botox injections into muscles and tissue around these areas has also proved effective.