American Society for Peripheral Nerve

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Magnetic Resonance Neurography To Detect Occipital Nerve Compression In Migraines
Kyle Sanniec, MD1; Lyahn Hwang, MD2; Avneesh Chhabra, MD3; Ronnie Pezeshk, MD2; Bardia Amirlak, MD4
1University of Texas Southwestern Medical Center, Dallas, TX, 2UT Southwestern, Dallas, TX, 3University of Texas Southwestern, Dallas, TX, 4Plastic Surgery, University of Texas at Southwestern, Dallas, TX

Objective: Migraine is one of the most prevalent and debilitating neurological disorders with limited modes of diagnosis and treatment. The development of magnetic resonance images of peripheral nerves, also known as magnetic resonance neurography (MRN), allows improved assessment of nerve anatomy and pathology. This study's objective is to demonstrate that magnetic resonance neurography can be qualitatively used to evaluate abnormalities in greater occipital nerves in patients with unilateral occipital migraines.

Methods: In this study, a retrospective chart review was conducted on a consecutive series of patients who met the criteria for possible unilateral occipital nerve compression based on history and physical exam and subsequently underwent bilateral occipital nerve magnetic resonance neurography. Subject demographics, characteristics of migraines, previous treatment measures, MRN findings, and operative findings were noted. Greater occipital nerve enlargement or hyperintensity and other possible pathologies related to migraine symptoms were recorded.

Results: Among 14 subjects with unilateral occipital migraines, 12 (86%) patients had MRN findings consistent with laterality of migraine symptoms, such as enlarged or brighter nerves on the symptomatic side compared to the asymptomatic side, and 2 patients (14%) had MRN findings that did not parallel the patient's clinical history or physical exam.

Conclusions: This study confirms that magnetic resonance neurography can qualitatively demonstrate abnormalities of the greater occipital nerves in patients with unilateral occipital migraines.

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