Abstract
Although there is increasing evidence of migraine headaches having extracranial origins,
the exact mechanisms underlying the pathogenesis of surgically treated migraines continue
to be poorly investigated and described.
We studied the microscopic and ultrastructural characteristics of superficial temporal
artery (STA) and occipital (OA) artery in the auriculotemporal and great occipital
trigger points of migraine patients to determine their possible role in migraine etiopathogenesis.
Fifteen biopsies, 10 of STA and 5 from OAs, were collected intraoperatively during
migraine surgery and immediately processed for optical and ultramicroscopic analysis.
We detected the following anomalies in all the specimens: (a) endothelial damage with
internal elastic lamina fragmentation and intimal thickening; (b) marked irregularity
in the shape and metachromasia of the vascular smooth muscle cells (VSMCs), separation
of cells by abundant extracellular matrix and vacuoles. The electron microscopy analysis
confirmed that presumed VSMCs infiltrated the intima layer revealing a consistent
shift of VSMCs from contractile to synthetically active phenotypes, endosome-like
organelles, multilamellar structures, abundant extracellular vacuoles filled with
fine granular material and membranes, and extracellular vesicles in the matrix space
surrounding synthetically active cells.
Our study revealed specific alterations in the vasculature at the neurovascular bundles
of the temporal and occipital trigger sites. These findings are indicative of an active
involvement of the arteries in the auriculotemporal and great occipital trigger sites
in evoking migraine.
Keywords
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Article info
Publication history
Published online: August 21, 2022
Accepted:
August 16,
2022
Received:
March 28,
2022
Footnotes
Presented, in part, at the 75th BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgey) Scientific Meeting, London, UK, October 28, 2021, at the 90th Annual Meeting of the American Society of Plastic Surgery, Atlanta, USA, October 29 – November 1, 2021, at the 65th National Congress of the Japan Society of Plastic and Reconstructive Surgery – Osaka (Japan), April 20-22, 2022, and at the International Confederation of Plastic Surgery Societies (ICOPLAST) World Congress – Lima, Perù, May 19-21, 2022.
Identification
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© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
