The role of the corrugator supercilii and its impact on the evolution of migraine medicine: A narrative review
Andrew Blumenfeld, Katrina A. PasaoAbstract
Objective
To review the historical significance, mechanism of action, anatomy, procedural techniques, injection complications, and emerging clinical implications of the corrugator supercilii muscle in the treatment of chronic migraine with onabotulinumtoxinA.
Background
The corrugator supercilii muscle occupies a unique position in headache medicine as the anatomical site central to the initial observations that led to the development of onabotulinumtoxinA as a preventive therapy for chronic migraine. The supraorbital and supratrochlear nerves are closely aligned with the corrugator muscle, and thus this muscle can provide a path to the trigeminal pain pathways. Observations of migraine improvement following aesthetic botulinum toxin into the glabellar region ultimately led to its use as an effective chronic migraine preventive therapy.
Design
A focused review of the literature was performed on PubMed with search terms including “migraine,” “onabotulinumtoxinA for chronic migraine treatment,” “pathophysiology of migraine,” “anatomy of the corrugator muscle,” and “history” with date ranges to only include recent peer‐reviewed literature published after 2000 to evaluate the historical origins, anatomical features, and clinical importance of the corrugator supercilii muscle in migraine management.
Results
Current evidence suggests that onabotulinumtoxinA is an effective treatment of chronic migraine that exerts its therapeutic effects through cleavage of synaptosomal‐associated protein 25 (SNAP‐25), preventing vesicular fusion and resulting in inhibition of neuropeptide release and receptor expression, which reduces peripheral and central sensitization. Accurate understanding of the corrugator supercilii anatomy is essential for optimizing treatment outcomes and minimizing adverse effects such as ptosis.
Conclusion
The corrugator supercilii muscle has played a pivotal role in the evolution of migraine treatment. Its unique relationship with trigeminal sensory pathways provides important insights into migraine pathophysiology, treatment mechanisms, and future applications extending beyond headache medicine.