Occipital Neuralgia vs. Migraine Headache

Today on Facebook I got a great question that I think is important….  “Are ON flares also called migraines?”

In fact the word “migraine” has a broad meaning, including many different kinds of severe headaches with different causes.  Some migraines are caused by issues in or near the brain, such as dilated blood vessels or actual disease of the brain tissue.  Other “migraines” are caused by neuralgias, or inflammation and/or dysfunction of compressed nerves outside of the skull- in the case of ON, the occipital nerves found in the back of the head affected.

Other neuralgias, such as those of the nerves in the forehead or near the temple, can cause severe headaches, too.  Many patients with neuralgias have a diagnosis of “migraine headaches” because their diagnosing doctor is unfamiliar with the proper diagnosis.  This means that many patients who have a diagnosis of migraine headaches actually have occipital neuralgia as the cause of their “migraines.”  That said, neuralgia patients can have different symptoms and different pains in different areas as well.  Some ON sufferers don’t have headaches at all.

Some patients have migraines from other causes IN ADDITION to occipital neuralgia.  These patients can suffer from multiple types of headaches, each from different causes.  And some patients have neuralgias of several different nerves, and release of each of these nerves can be therapeutic.  That is why migraine surgeons such as myself use directed nerve blocks to map out the “neuralgic” nerves that can be helped with decompression.

So, while some patients with occipital neuralgia have a diagnosis of “migraines” not all patients with migraines have occipital neuralgia.  This terminology conundrum also applies to what we surgeons call ourselves and what we call the surgery that we perform.

The peripheral nerve decompressions that we do are broadly termed “migraine surgery” so patients with a migraine diagnosis who really have headaches from neuralgia can understand that this type of surgery can help them.  Most headache patients would not understand what a “neuralgia surgeon” does, and so would miss out on the opportunity to have an evaluation and possibly a surgical release and headache relief.

I prefer the term “headache surgery” to “migraine surgery”, but in fact we are performing “nerve decompression surgery for the treatment of peripheral neuralgia and secondary relief of severe headache pain.”  But that is too much of a mouthful.

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