With the occurrence of constant pain at the back of the head or upper neck, occipital nerve decompression surgery is a procedure that is suggested by doctors. This pain is not the one that can be tolerated; it can stab, burn or feel like sudden electric shocks. The purpose of the surgery is to deactivate the occipital nerves that are inflamed, compressed or pinched by the condition known as Occipital Neuralgia. When medications and other conservative treatments do not help, surgery is conducted to deactivate those nerves in order to relieve pain in occipital neuralgia.
What is happening to these nerves?
The occipital nerves–the Greater and Lesser occipital nerves–innervate the upper end of your spine–closer to your C2 and C3 vertebrae–then travel through muscle/tissue at the posterior of your head and bifurcate over your scalp. Simply compressing them—by tight muscles, scar tissue, blood vessels or an injury—will make them abnormally excited, resulting in inappropriate signals to your body, and interpreted as pain as your brain perceives this. This, then, leads to that continuous achy feeling, burning, and/or even that quick jolt of pain sensation behind your ears, on your scalp and/or even on the back of your head.
When do the doctors actually refer to surgery?
It is not the first option for them. Typically, you will have to try: anti-inflammatories and muscle relaxants medications, physical therapy, possibly occipital nerve block for migraine (where a syringe with an anesthetic is placed near the nerve), or even Botox shots. If a nerve block provides you with relief, it is a really good indicator that the occipital nerve is the one causing the problem. Imaging such as MRIs or CT scans assist in ruling out other issues, but they do not always detect the nerves being compressed. If nothing else proves effective and your symptoms are still in line with nerve compression, that is when surgery becomes the solution.
What takes place during the surgery?
The physician performing the procedure uses a small incision behind the hairline at the base of the neck to enter the body and address the nerve injury. They then gently release the nerve from the pressure of the tight muscle, thin bands of tissue, blood vessels, or scar tissue. In some cases, a small amount of fat or other soft tissue may be used as a cushion to protect the nerve from future irritation. The focus is always to avoid injury to the nerve as much as possible. The objective? To work to deactivate the nerve by preventing irritation and worse pain after occipital nerve block signal transmission to the brain. Most procedures take a few hours, and many patients go home on the same day, however, sometimes, an overnight stay in the hospital is necessary.
What are the risks and benefits?
The advantages can be tremendous: diminished pain, less frequent headaches, lower dependence on pain relievers, and simply improved daily life. This is supported by research—one study reported that approximately 77% of patients experienced a reduction in headache occurrences after undergoing greater occipital nerve decompression. Of course, there are no certainties. Outcomes are determined by selecting the appropriate patients, the skillfulness of the surgeon and the surgical technique. Besides, there are risks like any other surgery—infection, bleeding, pain at the incision site, or altered sensation on the scalp such as numbness, tingling, or just the feeling of something being “off.” In some rare situations, the pain continues; additionally, it may even resume occurring or require treatment afterwards or another surgery.
What should you expect regarding recovery and aftercare?
The recovery process can vary based on the surgeon and the amount of nerves involved. In many cases, the surgery is outpatient surgery, and patients return home on the same day or shortly after. The first thing that you must expect is a little soreness, swelling, and possible numbness at the incision—but it tends to go away within a couple of weeks.
Occasionally, some headaches or discomfort can last longer but most people notice an alleviation of pain. The three to six weeks of being advised to take it easy for three to six weeks—no heavy lifting or intense workouts—are the ones hardest to follow. However, light physical activity, especially walking, is generally permitted soon after. Routine follow-ups will be scheduled to ensure your progress in recovery, your pain has reduced, and your health has improved. Always be aware of the prescribed manner for the wound care, pain, and pressure relief during recovery.
Is this surgery for everyone who has occipital neuralgia?
No. Not every person is a suitable candidate. The ideal candidates are individuals that have undergone a full evaluation, have documented or highly likely occipital nerve entrapment, and have failed from many trials of treatment. Also important to keep in mind when considering surgery, is to have a reasonable expectation as decompression will not fix every headache trigger someone might have, as it is only treating the nerve entrapment.
For instance, if a patient has headaches related to central nervous conditions or hormonal changes, they will, in general, not respond positively to surgical intervention. This is an important consideration when deciding prior to surgery on whether or not decompression is justified in a patient. Discussion with the patient’s neurosurgeon/neuro headache expert will assist in this decision.
Conclusion
Again, the recommended plan of action, where nerve compression is a significant issue, will be to relieve it when possible. If you suffer from persistent occipital pain that you describe as sharp, burning, or stabbing, and not much else has really helped, then maybe the occipital nerve decompression surgery will be able to give you hope after all. Rather than merely masking the pain, this surgery addresses the root problem, and thus some patients get a real chance for enduring relief.
It is not a miraculous solution. The success heavily relies on the proper identification of the diagnosis, the presence of an experienced surgeon, and the understanding of the exact situation. However, many people experience it as a watershed moment: the headaches diminish, the pain subsides, and their quality of life improves. In case your physician suspects that your headaches are a result of occipital nerve compression, refer to decompression—you may surprise yourself with the comfort you have been looking for.
