Semin Musculoskelet Radiol 2023; 27(S 01): S1-S24
DOI: 10.1055/s-0043-1770016
Oral Presentation

Role of High-Resolution Ultrasonography in Migraine

Dr. Deborah Bianco
Dr. Federico Zaottini
Dr. Riccardo Picasso
Dr. Federico Pistoia
Luca Tovt
Dr. Michelle Pansecchi
Dr. Simone Rinaldi
Dr. Marta Macciò
Gabriele Rossi
Prof. Carlo Martinoli

Purpose or Learning Objective: (1) To evaluate if high-resolution ultrasonography (HRUS) can visualize the greater occipital nerve (GON) along its entire course; and (2) to identify pathologic nerve alterations in patients with migraine headache (MH) and candidates for surgery.

Methods or Background: In patients with untreatable MH symptoms, excellent results are achieved through surgical GON neurolysis and focal occipital artery ligation. All candidates for surgery were examined using a 22–5 MHz probe. The GON size superficial to the obliquus capitis inferior, at the level of the trapezius fascia perforation, the occipital artery diameter at the crossing point over the GON, and the presence of GON alterations was recorded and compared with a sex- and age-matched healthy volunteer group. Two observers measured the nerve in healthy volunteers, and their agreement was evaluated with intraclass correlation coefficient statistics. The statistical significance of the measures between the volunteer and healthy group was evaluated with the t test.

Results or Findings: The study enrolled 25 patients, 14 women (mean age: 43 years; mean body mass index [BMI]: 21) and 11 men (mean age: 51 years; mean BMI: 24) and 25 matched healthy volunteers. The GON had been identified in all subjects with high interobserver agreement. HRUS pathologic findings, such as nerve enlargement in the piercing point of the trapezius fascia or perineural fibrosis, were found in 50% of patients. All the findings were confirmed during surgery. No significant differences in the anatomical parameters investigated between healthy subjects and patients (P = 0.05) were found.

Conclusion: The study showed that HRUS is reliable to depict the anatomical course of the GON and assess the point of possible neurovascular conflict. HRUS can also demonstrate pathologic nerve changes in a subgroup of patients.

Publication History

Article published online:
26 May 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA