Surgical Treatment of Intractable Unilateral Cephalalgia

The conquest of headache can be accomplished only by separation into various clinical entities and the application to each entity of specific drugs or surgical therapy. The vascular element contributing to the propagation of migraine has been frequently demonstrated. Harris 1 in 1936 pointed out the association of vasomotor changes in the cerebral vessels as demonstrated by scotomas, transient paresis, mental depression and visual field disturbances. Clark, Hough and Wolff 2 found that headache was due to excessive pulsation and stretching of the walls of the dural and temporal arteries. Penfield, 3 Harris and Penfield and McNaughton 4 caused relief from a migrainous headache by selective section of the upper fibers of the trigeminal root which interrupted the sensory fibers to the dura and scalp traveling beside the blood vessels. However, in Penfield's operation to expose the trigeminal root, he must have severed the middle meningeal and temporal arteries as