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HeadWay, Issue #134 -- Is this Headache Surgery for You?
September 21, 2015

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In this issue:

Occipital Nerve Decompression Procedure

Say what?! Transpalpebral

Occipital Nerve Decompression Procedure

As any headache sufferer could tell you, the idea of just cutting out the pain - completely and permanently - is very attractive. That's why so many of us are interested in the promise of surgical procedures for pain conditions such as migraine.

But there are good reasons why migraine surgery has been so controversial. And the occipital nerve decompression procedure is an excellent example.

This particular procedure is often used for occipital neuralgia, a condition characterized by sharp, shooting pain in the back of the scalp, sometimes shooting up toward an eye. The pain runs along the occipital nerves.

But isolated occipital neuralgia is rare - more likely, something about these nerves is working with other factors to trigger a migraine attack.

The occipital nerve decompression procedure "decompresses" a nerve by cutting away tissue that may be causing irritation.

Now, here's where things get tricky. The nerves are not the cause of migraine pain, but a trigger. So what we're doing with this surgery is not curing migraine, but eliminating one possible trigger.

Now, if this is a major trigger for you, the surgery may help, although it's unlikely to eliminate your migraine attacks altogether.

There are a number of reasons why this and other surgeries for migraine have been controversial - questions about how clinical trials have been done, and how to interpret the evidence, for example.

But perhaps the biggest issue is this. Is it worth the risks of surgery (even though we are told it's a "safe" and "easy" surgery)? And if so, for whom?

Migraine surgery has gained some acceptance, but usually under very strict rules about who should qualify. Here are some of the common suggestions:
  1. The patient should be under the care of a migraine specialist (a neurologist). Although doctors from other disciplines can perform the occipital nerve decompression procedure, it's critical that an neurologist experienced with headache conditions is also involved.
  2. The patient should already have tried a wide variety of non-surgical migraine treatments. Sometimes doctors will say you should have already tried "everything" - in this day and age, that's really not possible, because there are so many options. However, in my opinion if you haven't worked with a specialist for several years trying various well-researched treatments, you should probably steer clear of surgery. More on this below.
  3. An examination from a doctor experienced in the procedure is very important. They will know which symptoms to look for - symptoms that will tell them whether or not the surgery may work for you.
  4. The patient should try other "nerve-numbing" procedures first. That is, an occipital nerve block - an injection of medication. This will show just how much your occipital nerves are contributing to your migraine symptoms. If the nerve block doesn't give significant improvement, it's unlikely that the occipital nerve decompression procedure will.
Why in the world would you wait so long before trying surgery? Well, remember that this addressing only one possible trigger for migraine attacks. Many migraine medications and treatments have a much higher likelihood of fighting migraine overall. It is very likely that you will still have attacks after the surgery, unless you're a rare person whose attacks are almost exclusively triggered through the occipital nerve. Even so, the surgery may provide temporary results. Recovery from surgery also may take several weeks, as nerve adjust to the new reality.

The point is not that everyone should avoid occipital nerve decompression like the plague. It has been helpful for certain people. But you owe it to yourself to do your homework and look at all the options available to you, rather than jumping on something that sounds good but may not work for you.

For more information:

Say what?! Transpalpebral

There's a fun word to use casually at the dinner table tonight! Sometimes when performing a decompression of the occipital nerves, surgeons will take a transpalpebral approach. Basically this means that they will enter through your upper eyelid / eyebrow area in order to do the surgery. "Palpebral" is an adjective which refers to the eyelid.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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