Peripheral Occipital Nerve Decompression Surgery in Migraine Headache

Abstract

Background: Migraine headache in the occipital region is characterized by a recurrent pain of moderate to severe intensity. However, the diagnosis can be difficult because of the multitude of symptoms overlapping with similar disorders and a pathophysiology that is not well-understood. For this reason, the medical management is often complex and ineffective. Methods: A literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted to evaluate the surgical treatment of occipital migraines. Inclusion criteria were: English language, diagnosis of migraine, occipital neuralgia, or tension headache in compliance with the classification of the International Headache Society, follow-up at minimum 3 months, and adult age. The treatment had to consist of peripheral occipital nerve surgery. Results: 323 records were identified after duplicates were removed, 30 full text articles were assessed for eligibility, and 9 records were selected for inclusion. A total of 1046 patients were included in the review. General positive response after surgery (>50% reduction in occipital migraine headaches) ranged from 80.0% to 94.9%. However, many differences in the selection of patients, target of decompression surgery, and measurement outcome were described. Conclusion: Despite the decennial proven effectiveness and safeness of surgical therapy for chronic occipital migraine headaches, more significant proof is needed to definitively confirm its use as a standard therapy.

“Migraine Surgery and Determination of Success Over Time by Trigger Site: A Systematic Review of the Literature”

“…Our results agree with previous systematic reviews that support the effectiveness of migraine surgery for site IV. 14,19 In particular, our study observed that migraine surgery can be successful as early as 6 months compared to other trigger sites. Lee et al 32 conducted a retrospective study to evaluate whether removing the third occipital nerve, which is often encountered during the dissection for greater occipital nerve decompression, offers any additional benefit in surgical outcomes.…”

“…10,11 Deactivation of these peripheral trigger sites has been shown to improve symptoms. [12][13][14][15][16][17][18][19][20] Despite significant results after surgery, the differences in success rates and the subjective report of surgical outcomes in some studies have limited evaluation of its efficacy. Many of these patients undergo deactivation of nerves in multiple trigger sites; thus, determination of surgery success by specific trigger site has been difficult to report.…”

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery

“…Since Guyuron’s initial description, 1 numerous studies have been carried out around the world, unequivocally demonstrating the validity of this approach. 2–24 This approach is based on the neurolysis of extracranial nerves, which, when inflamed, act as trigger points and, as such, trigger headache attacks. Two of the nerves most frequently involved are the greater occipital nerve (GON) and lesser occipital nerve (LON).…”

Morphological features of the greater occipital nerve and its possible importance for interventional procedures

“…The aim of the decompression surgery of GON is to release potential compression points of GON and liberate the nerve (Bovim et al, 1992 ; Muehlberger, 2018 ). Knowing the anatomy and potential entrapment points of GON in detail is essential to achieve a successful decompression surgery (Baldelli et al, 2020 ).…”