Tips for the surgical treatment of occipital nerve-triggered headaches

Background: Literature from the last decade has shown a correlation between resection of the forehead and/or occipital muscles and relief from migraine headaches. Methods: The study cohort was 13 patients presenting with well-defined occipital nerve-triggered headaches unresponsive to conservative treatment. We undertook a modified version of the currently used method of occipital migraine surgery. Patients completed questionnaires before and after surgery, and results were compared. Results: To identify all trigger points, we used a constellation of symptoms referred to by the patient rather than injection of botulinum toxin type A. The entire procedure was carried out under local anesthesia. It also involved possible isolation of the lesser occipital nerve due to its potential compression sites. No flap was transposed for the purpose of covering isolated nerves. In 11 of 13 patients (85 %) in whom a dilated/aneurysmal occipital artery was found, the procedure was limited to ligation of the occipital artery, with no further undermining of muscles or neurolysis, which reduced the invasiveness of the procedure considerably. Conclusions: The main differences between our procedure and the currently used method were that (i) extensive undermining or muscular resection was not necessary and (ii) no flap was transposed with the purpose of covering isolated nerves. Hence, our method could improve the currently used method while minimizing its invasiveness and shortening the duration of hospitalization. Level of Evidence: Level IV, therapeutic study