The Current Means for Detection of Migraine XXXX Trigger Sites.

@entity1 @entity2704 @entity158 @entity10 @entity616
UNASSIGNED: The authors' 15-year experience with @entity2704 surgery has led them to believe that the most common reasons for incomplete response are failure to detect all of the trigger sites or, on rare occasions, inadequate surgery on the trigger sites. Thus, accurate identification of trigger sites is essential. The purpose of this article is to share the authors' current stepwise algorithm for accurately detecting the @entity2704 trigger sites, which has evolved through surgery on nearly 1000 @entity1 . To begin, a thorough history is taken. Each @entity1 's constellation of symptoms can point toward one or multiple trigger points. The @entity1 is asked to point to the most frequent site from which @entity2704 originate with one fingertip, and then the site is explored with a Doppler. If an arterial Doppler signal is identified at the site, it is considered an active arterial trigger site. Response to a @entity616 with a local anesthetic in a @entity1 with an active @entity2704 @entity10 confirms the presence of a trigger site. If the @entity1 does not have @entity158 at the time of the office visit, an injection of botulinum toxin A at the suspected trigger site may be considered. Although positive responses to botulinum toxin A and @entity616 are very helpful and reliable in confirming the trigger sites, negative responses must be interpreted with extreme caution. In @entity1 with a @entity2704 @entity10 starting from the retrobulbar site, a computed tomography scan of the paranasal sinuses is obtained to look for contact points and other pathology that would confirm rhinogenic trigger sites.
