Peripheral Nerve Surgery: New Advances in the Treatment of Occipital Neuralgia and Headaches

According to the National Headache Foundation, an estimated 28 million Americans suffer from migraines. Women are three times more likely to suffer from migraines than men, and 70 to 80% have a family history of migraines. This has significant impact on the quality of life of these patients, as well as days lost from work. Recent reports indicate involvement of several nerves in headache generating pain (supraorbital, supratrochlear, zygomaticotemporal, and greater occipital). It is also postulated that muscle spasm, in addition to an abnormal nerve path, leads to a nerve compression and thus to symptomatic migraine headache.

Fifteen patients who had occipital neuralgia with headaches for a minimum of 1 year (range: 1 to 25 years), were randomly selected. Patients were treated by a headache-specialized neurologist for at least 1 year without noticeable improvement in migraine headaches. Patients also had local and spinal nerve blocks, both of only temporary benefit in relieving pain. Neurolysis of the greater occipital nerves was done. Patients were followed postoperatively by plastic surgeon and neurologist. Intraoperative findings were compared to anatomical cadaver dissections (15). All patients reported improvement with surgery, while 13/15 (86.6%) reported elimination of migraine headaches.

The authors' algorithm and operative procedure, that differ from recent reports in the literature, were discussed. This study confirms the importance of peripheral nerve surgery for occipital neuralgia and migraine headache.