Cranial and Cervical Muscular Weakness in Mitochondrial Myopathy Is Associated With Resolution of Migraine Headaches: Further Evidence That Muscular Compression of Cranial and Peripheral Nerves Is a Cause of Headache in a Subset of Patients With Migraine

Objective: A significant subset of patients with migraine headaches has pain relief after neuroplasty/muscular decompression of select cranial and cervical nerves. In the ma-jority of cases, compression occurs secondary to compression of the nerves by adjacent muscles. Previous studies have shown that both surgical decompression and chemical denervation (eg, botulinum toxin) provide relief of migraine headaches; however, con-troversy remains. If somemigraine headaches are caused by muscular compression, then paresis of the compressing muscles by underlying myopathic/metabolic disease should result in migraine relief in some patients. Methods: We report a case of mitochondrial myopathy causing weakness primarily of the muscles of facial expression and the neck in the context of chronic migraine headaches (>20-year history). Muscle biopsy was obtained to confirm the myopathic diagnosis.Results: There was complete resolution of the patient’s migraine headaches that occurred simultaneously with the onset of symp-tomatic paresis of the muscles of facial expression and the neck. The relief has persisted for more than 10 months. Neurologic evaluation and muscle biopsy confirmed a diag-nosis of mitochondrial myopathy. Conclusions: Pathologic paresis/paralysis of facia