Journal of Child Neurology
Original Article
Compression of Superficial Temporal
Arteries by a Handmade Device: A Simple
Way to Block or Attenuate Migraine
Attacks in Children and Adolescents
Carlo Cianchetti, MD, Maria Celeste Serci, MD, Tiziana Pisano, MD, and
Maria Giuseppina Ledda, MD
Because a prolonged compression of the major scalp arteries
blocks migraine attacks in a substantial number of patients,
we studied the effect of the use of a simple handmade
device in blocking an incoming headache attack in children
and adolescents. Thirty-seven consecutive ambulatory
patients were instructed to apply, at the onset of each
migraine attack, a handmade device firmly compressing
both temporal arteries. Thirteen patients interrupted treat-
ment because of intolerance of the local pain provoked by
compression of the device. Of the remaining 24 patients,
M
igraine is not infrequent in children and adoles-
cents. Reported prevalence data by age groups
are 1.2% to 3.2% (male > female) for 3 to 7
years old; 4% to 11% (male ¼ female) for 7 to 11 years old;
and 18% to 23% (female > male) for 11 to >15 years old.1
Migraine attacks lead to the use of drugs, like analgesics
and triptans, which possibly should be avoided in children
and adolescents.
We recently showed that prolonged compression of the
major scalp arteries blocks pain in a high percentage of
migraine headache attacks, both in adults and in children
and adolescents.2 Compression should last at least 3 min-
utes, although sometimes 4 to 5 minutes is necessary.
Moreover, we found that an anesthetic (lidocaine) and,
surprisingly, simple saline (3 mL) around the superficial
Received January 17, 2009. Accepted for publication January 17, 2009.
From the Department of Neurosciences, Clinical Section of Neuropsi-
chiatria Infantile, Azienda Ospedaliero-Universitaria, Cagliari, Italy.
The authors have no conflicts of interest to disclose with regard to this
article.
Address correspondence to: Carlo Cianchetti, Department of Neuro-
sciences, Clinical Section of Neuropsichiatria Infantile, Via Ospedale
119, 09124 Cagliari, Italy; e-mail: cianchet@unica.it.
Cianchetti C, Serci MC, Pisano T, Ledda MG. Compression of superficial
temporal arteries by a handmade device: a simple way to block or attenuate
migraine attacks in children and adolescents. J Child Neurol. 2010;25:
67-70.
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Volume 25 Number 1
January 2010 67-70
# 2010 The Author(s)
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17 reported benefit from using the device and 7 no effect.
In these 17 patients, the percentage of attacks aborted or
attenuated by early use of the device was 90.5% in the first
month and 95.7% in the second month; the consumption of
antipain drugs dropped from the mean 4.4 + 2.6 in the pre-
device month to 1.3 + 1.6 in the first and 0.6 + 0.9 in the
second month.
Keywords: migraine; temporal artery compression; device;
headache mechanisms
temporal or occipital arteries could block headache pain.3
To have prolonged compression, we used a handmade
device and obtained relief in a relevant part of migraine
accesses in an adult population.4
Our results prompted us to verify whether the use of
such a simple device could have a blocking effect on single
migraine attacks in children and adolescents as well,
reducing the need for antipain drugs.
Materials and Methods
Participants
In all, 37 consecutive ambulatory patients, 26 females and
11 males, were involved. Their ages ranged from 8 to 17 years
(mean, 12.6 years, 3.1 SD + years). All were affected with
migraine, according to International Headache Society criteria.5
As inclusion criteria, in the past 2 months before the trial they
were required to have had at least 3 headache attacks, with no
change having been effected in any kind of preventive treatment.
An informed consent to perform the trial was obtained from
them and from their parents/caregivers.
Methodology
Apparatus. Participants were given a device capable of compres-
sing both superficial temporal arteries. The device (handmade,
67
68 Journal of Child Neurology / Vol. 25, No. 1, January 2010

Figure 1) consists of an aluminium band (12 mm large, 2 mm

thick, 38-40 cm long) bent like a horseshoe with a rubber pad
glued to each of its 2 ends. The device is worn like a headphone,
being careful that the pads are exactly over the superficial tem-
poral arteries at the level of the zygomatic arch in front of the ear
helix, to facilitate compression of the artery against the arch
bone. If this position is not sufficiently tolerated because of local
pain, pads can be applied immediately above the zygomatic arch.
Patients were repeatedly instructed regarding the correct
application of the device, particularly in finding the pulse of both
superficial temporal arteries and checking that the pads were
firmly compressing them. They were told to put on the device
as soon as possible in case of a migraine attack.

Contemporary treatments. No variations were allowed in the

preventive drug therapies the participant was undergoing for at
least 3 months before application of the device. A 3-month interval
was chosen to avoid any possible improvement in the 2 experi-
mental months due to the gradual onset of the effect of the drug.
Participants were also recommended to always use the same
drugs (triptans or other antipain drugs) against single attacks
that they had used in the month before applying the device; no Figure 1. Photo of the handmade device used.
other drugs or pharmaceuticals were allowed.
Results

Data registration. Each participant was given a sheet to use as a
diary. This was a grid, where on the y-axis 24 squares corre-
sponded to the hour of the day and on the x-axis the days of the
month. The patient recorded the presence of headache (a dot if
‘‘light’’; an x if ‘‘moderate,’’ that is partially interfering with daily
activities; a full black square if ‘‘severe,’’ that is fully interfering
with daily activities) in the squares corresponding to each hour
of the day when it occurred. Moreover he or she had to register,
on another similar grid on the lower part of the sheet, the use of
drugs (indicating the number of tablets or other preparations) for
each day, corresponding to the names of the drugs habitually
used by the patient, listed on the left-hand side.
Patients were instructed to keep the record for 1 month
before beginning regular use of the device and then for at least
2 months during its regular use. In that period, they had to draw
a circle around the squares of the hours of the day corresponding
to application of the device, which was to occur upon the first
appearance of pain.
Control procedure. As a control procedure, after using the
device for 2 months, patients and parents/caregivers were told
that we had found, from experience with other patients, that
positioning the pads about 1.5 cm in front of the original loca-
tion would be more efficacious in preventing headache. There-
fore, they were instructed to use this modified application of
the device. Use criteria remained unchanged: putting on the
device at the beginning of every headache attack.
Of 37 patients, 13 interrupted treatment during the first
month, 2 because of intolerance to the device (usually
pain provoked by compression); most of them also had
pain when digital pressure was applied on the temporal
arteries during and sometimes between headache attacks.
Of the remaining 24 patients, at the end of the trial,
7 reported no improvement, while 17 (13 females and
4 males) judged the device useful in blocking or reducing
the severity of migraine attacks.
The following data refer to the 17 patients who found
the device useful.
 All of them had migraine pain prevalently localized on
the forehead (sometimes including the orbits), mono-
or bilaterally.
 Mean duration of untreated migraine attacks was always
longer than 5 hours in 9 participants and longer than 3
hours in 5; in the remaining 3 patients, some attacks
lasted about 1 hour. Therefore, in these 3 patients, eval-
uation of the effect of applying the device was less
clearly valuable and subject to the judgment of the
patient himself.
 Participants did not always use the device for every
headache or at the onset of the attack: this was because
in most cases the headache began when they were at
school; in other cases, they were out and did not have
the device with them.

Data evaluation. In evaluating the results, we considered (1)
the patient’s positive or negative opinion regarding the useful-
ness of the device; (2) the number of attacks aborted, attenuated,
or fully developed while using the device; (3) the quantity of anti-
pain drugs used.
However, in almost all cases, attacks were blocked only
when they were of light or moderate severity; therefore,
delayed use of the device, after pain had markedly
increased or use in case of attacks with severe pain from
the onset, rarely caused improvement.

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Table 1. Migraine Attacks During the Trial in the 17 Patients Who Improved: Mean (+ SD) Values of the Total Number of
Attacks and of the Attacks Fully Developed, Attenuated, or Aborted Using the Device in the 2 Months of Triala
Total number of attacks
(A) No. of attacks fully developed despite use of the device
(B) No. of attacks aborted while using the device
(C) No. of attacks attenuated while using the device (at least 1 degree)
a. Comparison (paired t test): 1st month A versus B t ¼ 3.09, P ¼ .007, A versus C t ¼ 1.61, P ¼ NS, A versus B þ C t ¼ 3.94, P ¼ .001; 2nd month A versus B t ¼ 2.02,
P ¼ .062, A versus C t ¼ 2.29, P ¼ .035, A versus B þ C t ¼ 3.21, P ¼ .005. The values in parentheses represent the percentages of each group in each month.
Table 1 shows the results in these 17 patients. A very
significant difference was found between attacks showing
improvement (aborted or attenuated) with use of the device
as compared to attacks when the device was ineffective;
this occurred in both the first and second month. There-
fore, headache recurrence and intensity were significantly
reduced in both the first and second month of application
of the device, as compared to the pretreatment month.
As a consequence, participants used significantly fewer
antipain drugs. The quantity of tablets of antipain drugs
were as follows: in the predevice month 4.4 + 2.6; in the
first month of use of the device 1.3 + 1.6; in the second
month of use of the device 0.6 + 0.9. The reduction, as
compared to the predevice period, was highly significant
both for the first month (paired t test ¼ 5.15, P < .0001)
and the second month (t ¼ 5.55, P < .0001).
Age did not seem to influence the results, because no
significant difference was found in the mean age of parti-
cipants having positive versus those having negative
results (respectively, 12.7 + 3.2 vs 11.6 + 3.0; t ¼
0.79, P ¼ NS). The group of those not tolerating the
device had a similar mean age (12.5 + 2.7).
Table 1 shows that in the second month of trial, as
compared to the first month, there was a general reduction
in the number of attacks.
When, as a control procedure after the 2 months of
treatment, the device was applied near, but not on, the
superficial temporal arteries, all participants returned to the
preceding application site in not more than 4 weeks, with a
mean of 18.2 + 7.3 days, because practically no attacks
were aborted or attenuated when the device was placed at
the new location. With regard to further use of the device,
11 patients are still using it after 5 months and 4 patients
after 4 months.
Discussion
As confirmation of our preceding data,2 this study shows
that early compression of superficial temporal arteries
may block an incoming migraine attack.
In this sample, 17 (45.9%) of 37 children and adoles-
cents experienced improvement with use of the device at the
beginning of a migraine attack. Most of the nonimproving
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Treatment of Migraine Attacks / Cianchetti et al 69
1st Month 2nd Month
10.5 + 8.2 6.6 + 5.3
0.9 + 1.5 (9.5) 0.2 + 0.7 (4.3)
6.4 + 6.1 (61.0) 2.1 + 4.3 (52.9)
1.5 + 2.6 (29.5) 1.5 + 2.5 (42.8)
patients displayed intolerance to the application of the device
(13 participants, ie, 35.1% of the total), while among those
tolerating the device, 17 of 24 (70.8%) benefited from it.
Because a placebo effect is frequent in the treatment of
headache, we used the control procedure of a wrong appli-
cation of the device in the month following the 2 months of
the trials. The ineffectiveness of this application confirms
the efficacy of the correct use of the compressive device.
In children and adolescents, tolerance of the device
was much lower than in our adult sample, because in the
latter, only 6 of 30 (20.0%) did not tolerate it.4 However,
15 adults of the 22 completing the trial reported benefit
(68.2%)4 versus 17 of 24 children and adolescents
(70.8%). Although in children and adolescents use of the
device proved to be less beneficial than in adults, in a sig-
nificant number of children and adolescents it may still be
useful in relieving or blocking a migraine attack. The
importance of the application of the device at the first sen-
sation of pain should be underscored.
In our previous experience,2 we also found compres-
sion of the occipital arteries effective in some cases of
migraine attacks. Therefore, more patients could probably
benefit from using a device compressing the occipital
arteries as well. However, the device we constructed for
this purpose was rarely tolerated by patients.
The use of compression on the temporal scalp arteries
in relieving migraine is not completely new. In the past,
brief (20 seconds) digital compression of the superficial
temporal artery was found to relieve pain in a limited num-
ber of migrainous attacks6,7 and cluster headache
attacks.8 The mechanism by which compression works
can only be hypothesized. Data from our experience2-4sug-
gest an action on the afferent fibers of the pericranial
arteries carrying nociceptive impulses. Temporary neuro-
apraxia might be the consequence of firm compression
on the artery. As an alternative hypothesis, the stimulation
of afferent fibers by the device could gate centrally, for
example, at the level of the trigeminal sensory nucleus,
nociceptive impulses also coming from other sites. How-
ever, the latter hypothesis hardly explains the benefit we
3
obtained with periarterial injection of saline or lidocaine.
From the point of view of migraine mechanisms, the
relevant general finding of our preceding data,2,3 con-
firmed here, is that extracranial vascular and perivascular
70 Journal of Child Neurology / Vol. 25, No. 1, January 2010
structures are involved in at least a relevant percentage of
patients affected with migraine. Recent studies tend to
support these data.9
The trigeminovascular hypothesis by Moskowitz10 of
exclusive intracranial neurovascular involvement may oth-
erwise remain valid for some patients, like those who did
not improve with the device.
This study suggests a new way of treating migraine
without the administration of drugs, which may be useful
in a significant percentage of patients. On the basis of our
data in children and adolescents, at the onset of a migraine
attack, before the use of any antipain drugs, we propose
the application of this very simple device should be
attempted. The device may be easily used by anyone, and
its early application in a substantial part of attacks can
avoid the use of potentially dangerous antipain drugs.
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