Indications and Outcomes for Surgical Treatment of Patients with Chronic Migraine Headaches Caused by Occipital Neuralgia

Dučić, Ivica; Hartmann, Emily C.; Larson, Ethan E.

doi:10.1097/prs.0b013e3181a0720e

Cited by 121 publications

(143 citation statements)

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“…The contribution of the lesser occipital nerve to migraine was validated by the research of Dr. Ivica Duicic who found that excision of the lesser occipital nerve relieved headaches. 45 However, the third occipital nerve does not have a significant clinical impact on the outcomes of migraine surgery. 46 Furthermore, occipital nerve and occipital artery intersections, as well as the third occipital nerve, were once considered to be the less common trigger sites.…”

Section: Discussionmentioning

confidence: 99%

Experience of Surgical Treatment for Occipital Migraine in Taiwan

Lin

Jeng

et al. 2016

Annals of Plastic Surgery

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Section: Discussionmentioning

confidence: 99%

Experience of Surgical Treatment for Occipital Migraine in Taiwan

Lin

Jeng

et al. 2016

Annals of Plastic Surgery

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“…1 Although results of published series have been encouraging, with an average 85% success rate, there are inevitably a subset of patients who fail decompressive surgery and continue to suffer from chronic headaches. 2 In some other neuralgic syndromes, peripheral nerve ablation has been used as a method of pain reduction, presumably by severing the connection of the central nervous system with the peripheral sensory distribution of the target nerve. 3 The purpose of this report is to examine our experience with performing occipital nerve excision (denervation) for relief of continued occipital headaches in those patients who have both failed maximal medical management and previously undergone occipital nerve decompression.…”

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confidence: 99%

Greater Occipital Nerve Excision for Occipital Neuralgia Refractory to Nerve Decompression

Dučić

Felder

Khan

et al. 2014

Annals of Plastic Surgery

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Background: Patients who undergo occipital nerve decompression for treatment of migraine headaches due to occipital neuralgia have already exhausted medical options for treatment. When surgical decompression fails, it is unknown how best to help these patients. We examine our experience performing greater occipital nerve (GON) excision for pain relief in this select, refractory group of patients. Methods: A retrospective chart review supplemented by a follow-up survey was performed on all patients under the care of the senior author who had undergone GON excision after failing occipital nerve decompression. Headache severity was measured by the migraine headache index (MHI) and disability by the migraine disability assessment. Success rate was considered the percentage of patients who experienced a 50% or greater reduction in MHI at final follow-up. Results: Seventy-one of 108 patients responded to the follow-up survey and were included in the study. Average follow-up was 33 months. The success rate of surgery was 70.4%; 41% of patients showed a 90% or greater decrease in MHI. The MHI changed, on average, from 146 to 49, for an average reduction of 63% (P G 0.001). Migraine disability assessment scores decreased by an average of 49% (P G 0.001). Multivariate analysis revealed that a diagnosis of cervicogenic headache was associated with failure of surgery. The most common adverse effect was bothersome numbness or hypersensitivity in the denervated area, occurring in up to 31% of patients. Conclusions: Excision of the GON is a valid option for pain relief in patients with occipital headaches refractory to both medical treatment and surgical decompression. Potential risks include failure in patients with cervicogenic headache and hypersensitivity of the denervated area. To provide the best outcome to these patients who have failed all previous medical and surgical treatments, a multidisciplinary team approach remains critical.

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“…However, as its applicability continues to be proven to diverse and exciting problems, 2,3 growth in the population of both peripheral nerve surgeons and patients is bound to continue, as evidenced by recent publications with nerve procedures numbering in the hundreds to thousands. 3,4 As the specialty grows in size, it is bound to mature in refinement of technique and indications, and expectations for patient outcomes will become more standardized. As has occurred with other fields (general surgery, orthopedics, etc.…”

Section: Discussionmentioning

confidence: 97%