Introduction: What We Call It Matters
In medicine, terminology isn’t just academic. The words we use to name conditions and treatments shape how patients understand their options, how providers frame their evaluations, and ultimately, how people find their way—or fail to find their way—to relief. This is especially true in the world of chronic headache.
As interest grows in surgical interventions for headache relief, a subtle but powerful obstacle has emerged: a lack of shared language. Depending on the provider, the condition may be referred to as chronic migraine, occipital neuralgia, tension-type headache, or new daily persistent headache (NDPH). The treatment may be called “migraine surgery,” “headache surgery,” “nerve decompression surgery,” or simply “peripheral nerve release.” Each term evokes a different set of assumptions and associations. Each speaks to a different audience. And in the space between them, countless patients fall through the cracks.
The consequences of ambiguous or inconsistent terminology remains problematic in headache care. It looks at how diagnostic uncertainty, coupled with inconsistent naming conventions, prevents patients from accessing life-changing interventions. And it argues that for patients with anatomically-driven pain, the way forward begins not with a new procedure—but with clearer language.
The Headache Diagnosis Dilemma
Unlike many other conditions in medicine, headache diagnoses are not rooted in visible pathology. Instead, they are based almost entirely on patient-reported symptoms. The International Classification of Headache Disorders (ICHD) defines over 200 distinct headache types, categorized by frequency, duration, quality, and associated features. While comprehensive, this framework relies on subjective interpretation and symptom recall. Two patients with identical anatomical causes might receive completely different labels—one as migraine, another as tension-type headache, another still as NDPH—simply based on how they describe their experience.
This variability makes diagnosis both necessary and fragile. A patient with occipital nerve compression may be classified as having chronic migraine if their pain is unilateral and pulsating. Another with the same nerve involved, but who uses the term “pressure” instead of “throbbing,” may be told they have tension-type headache. And a third, whose pain began suddenly and never left, might be diagnosed with NDPH. None of these labels are wrong, per se—but none of them point clearly to the underlying cause, either.
This diagnostic ambiguity creates downstream problems when patients seek treatment. Medications are prescribed based on symptom clusters. Injectable “new generation” medications are offered based on labels. And surgical options, when considered at all, are introduced selectively—often only to those with a “migraine” or “occipital neuralgia” diagnosis. The result? Many patients who might benefit from peripheral nerve decompression never hear about it, simply because their condition is called by a different name.
Migraine Surgery, Headache Surgery, or Nerve Decompression?
Surgical treatment for chronic head pain is grounded in the idea that peripheral nerves—such as the greater occipital, lesser occipital, supraorbital, or zygomaticotemporal nerves—can become entrapped by muscle, fascia, or other anatomical structures. When these nerves are irritated, they send persistent signals that manifest as chronic pain. Releasing the nerve from these points of compression can lead to dramatic improvement or even resolution of symptoms.
But the name given to this procedure varies depending on who is describing it. Some surgeons refer to it as “migraine surgery,” a term that links the treatment to the most familiar headache diagnosis. Others prefer “headache surgery,” which broadens the scope but can seem vague. Still others use “nerve decompression surgery,” a more anatomically specific term that resonates with surgeons and anatomists but may confuse patients unfamiliar with neuroanatomy.
Each term carries pros and cons:
- “Migraine surgery” speaks to patients with a common diagnosis, but excludes others whose pain doesn’t meet migraine criteria.
- “Headache surgery” is inclusive but lacks precision. It risks sounding non-specific or even dismissive.
- “Nerve decompression surgery” is accurate, but often doesn’t appear in patient searches related to headache or migraine.
In the absence of a universally accepted label, patients must rely on terminology that may or may not match their diagnosis. A person with NDPH who searches for “NDPH treatment” is unlikely to encounter resources related to “migraine surgery,” even if their pain is anatomically identical to someone who qualifies under that label. This terminological disconnect creates an artificial barrier to care.
NDPH and the Problem of Language
Nowhere is the problem of terminology more exemplified than with new daily persistent headache. NDPH is characterized by the sudden onset of continuous daily headache that persists for more than three months. The condition is notoriously difficult to treat. It resists conventional medications. It often does not meet full criteria for migraine or tension-type headache. And because its cause is unknown, many physicians approach it with therapeutic nihilism.
But in clinical practice, many patients with NDPH exhibit symptoms that align with peripheral nerve compression. They describe tenderness at the occipital notch, aching in the temple, or pressure behind the eyes. These signs suggest an anatomical trigger. When examined carefully and tested with nerve blocks, some of these patients experience profound relief. And when operated on, they improve.
The problem is, very few NDPH patients are ever evaluated for nerve compression. They are told their condition is idiopathic. They are advised to manage stress, adjust expectations, and continue pharmacologic treatment. Meanwhile, “migraine surgery” is never mentioned—because they don’t have migraine.
This is where language becomes a gatekeeper. Because the procedure is called “migraine surgery,” it is assumed to apply only to migraine. Patients with NDPH do not seek it. Providers do not recommend it. And the possibility of resolution remains hidden in plain sight.
Toward a Better Vocabulary
To move forward, we need a vocabulary that reflects the anatomy of the problem, not just the symptoms it creates. That means shifting the focus from named diagnoses to observable mechanisms. Instead of asking “Do you have migraine?” we must ask “Where does it hurt? Can we reproduce the pain on exam? Does a nerve block relieve it?” These are anatomical questions, not categorical ones.
In this model, the term “nerve decompression surgery” becomes more useful. It emphasizes what is being treated—the entrapped nerve—rather than the label attached to the symptom. Likewise, “headache surgery” can be reclaimed as an umbrella term, encompassing procedures that address peripheral pain generators regardless of diagnosis.
Patient-facing language may still need to include familiar terms. It is reasonable to use phrases like “surgical treatment for migraine, chronic headache, and nerve-related head pain.” But the core messaging must center on what unites these conditions—not what separates them.
Educating Patients and Providers Alike
Solving the terminology problem requires both patient and physician education. Patients need to understand that surgical options may be available even if their diagnosis isn’t “migraine.” They need to know what nerve compression feels like, how it is tested, and how it is treated. Resources must speak to those with NDPH, tension headache, and even post-traumatic headache—conditions that often go unlinked to nerve-based interventions.
Clinicians must also be taught to recognize patterns of anatomical pain. They must learn how to examine for nerve tenderness, how to use diagnostic blocks, and how to refer appropriately. Importantly, they must resist the temptation to see a diagnostic label as the end of the conversation. The name matters—but not more than the body.
The Diagnosis Is Not the Destination
In chronic headache care, language is more than a description. It is a map. It guides patients toward or away from options. It determines whether someone sees themselves as a candidate for surgery—or never even considers it.
For patients with nerve-based head pain, the label they receive should not dictate the treatment they are offered. Whether called migraine, tension headache, or NDPH, the symptoms often share a common source: a compressed nerve. When we diagnose by anatomy instead of assumption, and when we speak in terms that reflect mechanisms rather than syndromes, we open the door to real solutions.
Headache surgery is not just for people with migraine. Nerve decompression is not just for those with a certain code on their chart. It is for anyone whose pain can be traced to a physical source. And the first step to making that clear—for patients, providers, and the public—is getting our language right.
While this blog has focused on headache surgery and its recovery journey, it’s important to note that many patients suffering from chronic migraines may also benefit from surgical intervention. Migraine surgery, which targets specific nerve triggers associated with migraine episodes, offers a potential path to lasting relief for those who have exhausted other treatments. If you or someone you know is struggling with frequent, disabling migraines, exploring migraine surgery with a qualified specialist could be a transformative step forward.
