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The Effectiveness of Lesser Occipital Nerve Decompression as an Alternative to Excision in the Treatment of Chronic Migraines
Ziv Peled, MD
Peled Plastic Surgery, San Francisco, CA
Introduction: The role of peripheral nerve decompression in the treatment of chronic migraine headaches represents a paradigm shift in the management of affected patients. One of the compression point trigger zones identified as a cause of such headaches is the occipital region. However, much of the published literature describes decompression of the greater occipital nerve and excision of the "minor" occipital nerves such as the lesser and third occipital nerves. The goal of this study is to assess outcomes after surgical decompression, rather than excision, of the lesser occipital nerves. Methods: Between May 2010 and March 2013, 23 patients underwent lesser occipital nerve decompression as well as decompression of any other peripheral nerve triggers. Data on headache frequency, duration and severity were prospectively collected and used to calculate a Migraine Headache Index (MHI) score, a validated measure of migraine pathology. Patients with less than three months of follow-up were excluded from the study. Data were analyzed using a two-tailed t-test for significance. Results: Mean post-operative follow-up from the 23 patients was 12.5 months. Analysis of the mean MHI scores from the group demonstrated a significant improvement in MHI scores from the pre-operative to the post-operative assessments (126.3 to 25.5, respectively, p < 0.0001). 8 patients (35%) reported complete resolution of their migraines. One patient had persistent discomfort over the involved lesser occipital nerve and required neurectomy with implantation of the proximal nerve end into the nuchal musculature; after this secondary procedure, she achieved a 73% reduction in her overall MHI score (88 to 24). All other patients reported normal gross sensation to light touch in the lesser occipital nerve distribution post-operatively with no incidence of neuroma formation. There were no post-operative complications in this series. Conclusions: Sensory neurectomy has several potential drawbacks, including the possibility of neuroma formation and permanent anesthesia in the involved nerve distribution. This study demonstrates that decompression of the lesser occipital nerve is a safe and effective approach to alleviating chronic headache pain that also preserves scalp and retro-auricular sensation
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