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Occipital Nerve Excision for Occipital Migraines Refractory to Surgical Decompression
John M. Felder, MD; Ivica Ducic, MD, PhD; Neelam Khan; Sojin Youn
Medstar Georgetown University Hospital, Washington, DC, USA
Background: Surgical decompression of the greater occipital nerve has emerged as a valuable alternative to medical therapy for chronic migraine headaches due to occipital neuralgia. However, not all patients obtain relief from decompression. This study investigates the effectiveness of occipital nerve excision for pain relief in patients whose headaches persist after nerve decompression.
Methods: A retrospective chart review was conducted to identify patients who underwent occipital nerve excision after decompression by the senior author. Pre-operative data were collected from patient charts and post-operative data was collected by a standardized electronic survey of patients.
Results: 60 patients were identified who had undergone greater occipital nerve excision for persistent occipital neuralgia following nerve decompression. Average age was 45 years (SD = 13), 79% were female, 18% had right-sided pain, 8% had left-sided pain, and the remainder had bilateral pain. 34% of patients had a history of head/neck trauma, 18% had had radiofrequency ablation of the cervical nerves, and 15% had a history of previous neck or back surgery. Mean migraine headache index ([days/month] x [pain 1-10] x [hours/24 hours]) was 151 preoperatively and 49 postoperatively (p <0.001). This represented a mean 61% change (p <0.001). 85 percent of patients reported some improvement following surgery, with 49 percent experiencing at least 50 percent pain relief and 21 percent reporting total relief. Surgical complications were limited to 2 wound dehiscences. Reported postoperative sensory changes ranged from numbness to bothersome dysesthesias. Minimum followup was 12 months. Detailed analysis of patient variables was performed to identify factors associated with success and failure.
Conclusions: Excision of the greater occipital nerve with implantation to muscle provides relief of headache pain in many patients who have symptomatic occipital neuralgia despite nerve decompression. Prospective studies will be valuable in determining what factors are associated with success versus failure.
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