Published March 28, 2019 By Adam Lowenstein

For better or for worse, nerve decompression to provide relief from headaches and neck aches has been come to be known as “migraine surgery” because many chronic headache patients carry a diagnosis of migraine disease.  It’s true that “Migraine Surgery” rolls off of the tongue better than “Peripheral Nerve Decompression Surgery for the Treatment of Pain Syndromes Including Chronic Headache, Tension Headache, Migraine Disease, and Occipital Neuralgia.”  That said, however, the terms can be confusing and it is a shame that many headache patients who could benefit from outpatient nerve decompression remain unaware that this outpatient surgery can provide permanent headache relief.

What does Nerve Decompression Surgery treat?

Nerve decompression surgery in the head and neck can provide relief from many different kinds of headaches.  Because of the inconsistency in headache diagnosis and terminology across many specialties and providers, it is understandable that there is confusion regarding so many aspects of headache disease.  Nerve decompression surgery can treat any pain syndrome that results from compression of the peripheral nerves in the head and neck, and this turns out to be the cause of many, many headaches in many, many people.  Along with migraine disease, the compression of several nerves in the head and neck can be the triggering culprit in both chronic headaches and particularly tension headaches.

In Tension Headache, patients often complain of tight and knotted muscles in the upper back and neck, with headache pain radiating from the upper neck to the rest of the head.  How many of us have tried to rub our necks in self- massage in order to find at least a little relief from our headache?  In fact, because so many of us hold tension in our neck and upper back, the tense muscles are tightening around the occipital nerves, and these nerves are sending distress signals back to the brain in the form of pain.  These distress signals then trigger a cascade of brain mechanisms that cause the rest of headache or migraine symptoms which can include globalized head pain, nausea, sensitivity to light, dizziness, or neck pain.

While many doctors will correlate a patient’s stress headaches with stressful lifestyle or poor sleeping habits, poor posture, or situational distress, the advice of “you need to relax” or the prescription of stress relieving modalities are often inadequate to relieve the deep muscular tension that the nerves are experiencing.  Patients with chronic headaches such as this often go from medication to medication, chiropractor to acupuncturist in the hopes of decreasing the headache pain.  Some of these headache sufferers find success with these conservative measures, and that is a fantastic thing for them.   Others, however, continue to suffer from their chronic headaches, stress headaches, or migraine disease without relief.  These are the patients who need to know about nerve decompression surgery and the 93% success rate that headache surgery achieves in reducing symptomatic pain.

How does Nerve Decompression Surgery improve headache pain?

Nerve decompression surgery is the procedure by which the nerves that are triggering headache and/or neck pain are released from constriction and pressure from the structures that surround and encase them.  Such structures can be tight muscles in the case of stress headaches, crossing blood vessels in the case of migraine disease, or connective tissue and sometimes even bone in patients with headaches or migraine disease coming from behind the eyes (also called “supra-orbital syndrome”).  The outpatient surgery that addresses these headaches involves small incisions that allow access to the involved nerves, which are found first and then traced through much of their course.  As these nerves are traced, tight muscles and other constricting structures are released to allow the nerve to lie in a relaxed fashion, free of pressure and irritation.  A fat pad is often placed next to the nerve to further protect it and provide a soft “pillow” on which the nerve can lie.  The release or decompression of the nerve in this fashion puts an end to the distress signals that the compressed nerve has been sending to the brain, and the pain syndrome is relieved.  Since nerve decompression surgery for headaches is an outpatient procedure, the entirety of the surgery usually takes two to three hours and the patients often find immediate relief from their headache pain.

How can you tell if Nerve Decompression Surgery will work on your chronic headache or stress headache?  (or Migraine Headache for that matter)

Figuring out if nerve decompression surgery is right for you is surprisingly easy.  Targeted Injection Mapping (more about that here) is the process of using nerve blocks of local anesthetic placed to the nerves in question, and seeing if these nerve blocks provide immediate pain relief.  In the vast majority of patients seen, they actually do.  Once a patient reports pain improvement following a nerve block, we know that the irritation of that nerve is a trigger of the headache pain.  Even if there is a tight muscle around the nerve causing distress signals, the nerve block will temporarily shut the nerve down so it is not capable of sending those pain signals, and the headache pain is relieved for a short time while the local anesthetic is working (usually two to four hours.)  Once a successful nerve block has shown that the nerve is irritated and triggering the headache pain, we can be pretty certain that decompression of that nerve can provide long-lasting headache relief if surgery is performed.

Learn the details regarding nerve decompression surgery for the relief of pain in cases of tension headaches, chronic headaches, migraine headaches, and occipital neuralgia.  Links to the following issues can provide a lot of educational materials.






To find out more information about nerve decompression surgery, call our Center at 805-969-9004.

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