Scalp periarterial saline efficacy in migraine and relation to exploding and imploding headache

We recently reported the possibility of blocking a migraine attack by prolonged compression of scalp arteries and by the injection of saline around them, suggesting a role of extracranial structures in migraine pain. This study attempts further characterisation of the effect of saline infiltration and the relationship of the response to headache characteristics. A total of 40 patients were examined for scalp artery tenderness (superficial temporal main trunk and frontal branch, and occipital) during migraine attacks. Pain characteristics (implosive vs. explosive) were also evaluated. On the basis of the reported pain location and artery compression performed in order to evaluate which one was possibly more involved in causing pain, periarterial infiltration was effected, 3–5 ml adjacent to each artery, beginning with the one believed to be more involved. Periarterial infiltration of 3–5 ml of saline caused relevant improvement in 82.5% of patients, with complete cessation of pain in 52.5% and >50% relief in 30.0%. Infiltration around only the superficial temporal arteries had the greatest effect in 35.0% of patients. No relationship between the type of pain and response to infiltration was noted. Our results confirm the possibility of obtaining relief from migraine pain using simple saline infiltration around scalp arteries, without drugs, in a large percentage of patients. Moreover, they suggest that at least in a substantial percentage of patients pericranial structures (probably the periarterial nociceptive afferents) are involved. The type of pain reported, implosive versus explosive, does not correlate with response to saline infiltration.