Anatomy of the auriculotemporal nerve: variations in its relationship to the superficial temporal artery and implications for the treatment of migraine headaches.

BACKGROUND Clinical experience with surgical decompression of specific peripheral nerves in the head and neck for the relief of migraine headache symptoms has proven to be effective in most patients. Some patients, however, continue to have residual symptoms after these procedures. In an effort to better understand potential etiologies for failure of treatment, an investigation was performed to determine whether or not vascular-mediated peripheral trigger points exist that have heretofore been undescribed that may be contributing to persistent symptomatology. One such potential trigger point is the superficial temporal artery's interaction with the auriculotemporal nerve. A cadaveric investigation was performed to advance this anatomical understanding of this relationship. METHODS Both sides of 25 fresh cadaveric heads were dissected in the preauricular and temporal regions. The superficial temporal artery and auriculotemporal nerve were identified and dissected both proximally and distally. Their relationship was examined, and a topographical map of their intersections was generated. RESULTS The auriculotemporal nerve and superficial temporal artery run together in the superficial soft tissue in the preauricular and temple regions. A contiguous relationship between the two was found in 17 hemiheads (34.0 percent). CONCLUSIONS There are variations in the relationship between the auriculotemporal nerve and the superficial temporal artery. These variations may serve as an anatomical explanation for this point as a source of migraine headaches in some patients. A topographical map of the relationship between these two structures may serve as a guide for surgeons interested in decompressing the nerve from the artery when indicated.