Chim Harvey
Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, Fla.
Plast Reconstr Surg Glob Open. 2022 Feb 22;10(2):e4145. doi: 10.1097/GOX.0000000000004145. eCollection 2022 Feb.
Diagnosis of trigger sites for migraine surgery relies on history to detect a constellation of symptoms and secondarily, nerve blocks, imaging studies, and Doppler probe examination. The scratch collapse test (SCT) has been described for localization of compressive neuropathies in the upper and lower extremities. In this study, we hypothesized that the SCT could also be used to diagnose trigger sites for surgical planning in migraine surgery. Eleven consecutive patients presenting for migraine surgery, and four patients presenting with recurrent headaches and secondary trigger sites after initial successful migraine surgery were examined with the SCT using a standard protocol to assess involvement of bilateral sites I, II, IV, V, and VI, with the carpal tunnel as a negative control. The SCT was positive bilaterally at sites I, II, IV, V, and VI for all patients presenting primarily for migraine surgery, regardless of trigger sites localized by history and other secondary modalities. The SCT, however, correlated with secondary trigger sites localized through history and examination for patients presenting with recurrent migraine headaches after previous primary surgery. The SCT is not reliable for localization of trigger sites in patients presenting primarily for migraine surgery. This likely relates to central sensitization of migraine headaches, leading to global cutaneous allodynia in the head and neck. In patients with recurrent migraine headaches, abrogation of central sensitization following the initial surgery allows diagnosis of secondary trigger sites through the SCT.
偏头痛手术触发点的诊断主要依靠病史来发现一系列症状，其次依靠神经阻滞、影像学检查和多普勒探头检查。划痕塌陷试验（SCT）已被用于定位上肢和下肢的压迫性神经病变。在本研究中，我们假设SCT也可用于偏头痛手术的手术规划中触发点的诊断。对11例连续前来接受偏头痛手术的患者，以及4例在首次偏头痛手术成功后出现复发性头痛和继发性触发点的患者，使用标准方案进行SCT检查，以评估双侧I、II、IV、V和VI部位的受累情况，以腕管作为阴性对照。对于所有主要因偏头痛手术前来就诊的患者，无论通过病史和其他辅助方法确定的触发点如何，SCT在I、II、IV、V和VI部位双侧均为阳性。然而，对于在先前初次手术后出现复发性偏头痛头痛的患者，SCT与通过病史和检查确定的继发性触发点相关。SCT对于主要因偏头痛手术前来就诊的患者触发点的定位不可靠。这可能与偏头痛头痛的中枢敏化有关，导致头颈部出现全身性皮肤痛觉过敏。在复发性偏头痛头痛患者中，初次手术后中枢敏化的消除使得通过SCT能够诊断继发性触发点。
