American Society for Peripheral Nerve

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Traumatic Birth As a Potential Cause of Early Onset Migraine Headaches
Saja Scherer, MD; Wassim Raffoul, MD; Giorgio Pietramaggiori, MD, PhD
Plastic Surgery Department, University Hospital of Lausanne, Switzerland, Lausanne, Switzerland

Introduction: The origin of chronic headaches are often unknown. Whiplash injuries or cranial surgery are described as a potential cause of chronic headaches. We here investigated traumatic birth as the trigger of migraine headaches that were present since childhood.

Methods: We screened the history of migraine patients of our headache clinic for potential cranial birth trauma that could be responsible for their chronic headaches. Two patients (54 and 30 yo) reported particulary traumatic birth with the use of forceps.

Results: Both patients presented with visible scars accross the head and suffered since early childhood from chronic headaches were refractory to pain medication. Chronic headaches were invalidating, rated as 6-7/10 during 15 and 30 days per month. Headaches were also causing the loss of more than 30 days per year of work for a patient and the complete inability to work for the other. Headaches responded positively (0/10) to a peripheral nerve block in multiple, selected triggers. Patients benefited from selective neurolysis in all known main migraine triggers (supra-orbital, supra-throchlear, zigomatico-temporal, auricolo-temporal, greater occipital, lesser occipital and third occipital). After one-year follow-up headaches significantly decreased leaving the patients headache free during most of their time and seldom with lighter pain responding to over the counter medications.

Conclusions: Traumatic birth can induce persistent deformations of the skull and mechanical and fibrotic damage to the sensitive nerves of the head. This may lead to chronic headaches since childhood. In our series, patients presented with multiple triggers, which responded well to neurolysis. Difficult birth should be investigated as a possible cause of nerve entrapment and patients may be good candidates for surgery.

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