While the term “migraine surgery” is now commonly used to describe the surgical treatment of headache pain, the name can be misleading because of the surgery’s ability to treat a wide array of different types of headaches. Beyond migraines and occipital neuralgia, atop the list of headaches that can be treated by nerve decompression surgery is the tension headache. Tension headaches are the most common type of headaches, affecting more than 20% of the human population.

What causes tension headaches?

Tension headaches can arise from many different causes. Stress or strain at work or home, or the even the things we do every single day including staring at computer or phone screens for long periods, or driving as part of a long commute may cause patients to “hold their stress” in their shoulders and back. With the unfortunate increase in life’s stressful nature, simply living with the normal day to day issues that arise is causing the incidence of tension headaches to continue to rise. Tension headaches are characterized by tension of the muscles in the head and neck, most often including the muscles in the back of the neck and upper back. The muscle contractions in the head and neck region contribute to the pain, and the discomfort caused by these headaches only creates more tension. The resultant ‘circle of pain’ where tight muscles create pain, and pain creates more tight muscles, is the reason why tension headaches can often last up to 4 hours of more. Patients with tension headaches often find themselves rubbing the back of their neck, back, or head in trying to loosen up the tight tissue that can be felt in this region. Massage, chiropractic care, and acupuncture are all modalities that patients often turn to with the hopes of loosing this tissue. These are often effective for reducing street and providing relief from tension and pain, but they are also merely temporary solutions that need to be repeated consistently to make a real impact.

The real underlying cause of tension headaches

While it is true that the tension of the muscles and tissue in the back of the head and neck are often the major contributing factor to tension headaches, it is actually the nerves that reside in these regions that are the main culprit. The Greater Occipital Nerve (GON) is the largest nerve in this area and arises from the cervical spine of the neck. This nerve courses through several muscle layers on its way to the skin of the scalp, where it supplies feeling to the the skin of the back of the head. The GON courses through the smispinalis capitis muscle, as well as the trapezius muscle during it’s course, and both of these muscles tent to be tight with tension in patients who experience tension headaches. Additionally, the Third Occipital Nerve (TON) which is a much smaller nerve branch also found in this area, takes a similar path through these often tight muscles.

On either side of the neck, the other culprit we find is the Lessor Occipital Nerve (LON). This nerve travels around a muscle called the sternocliedomastioid muscle which runs from the back of the skull to the collar bone. This muscle aids in stability and turning of the head, and is usually felt as a tight band in patients who complain of tension headaches.

In each of these cases, the muscles that are so often tight in tension headache patients are closely related to these nerves, the GON, TON, and LON. Because of the tightness of these structures, these nerves become chronically irritated, swollen, and inflamed. A nerve inflammation is called a neuralgia, and the the tension headache patient most often has neuralgia of one, two, or three of the these nerves on either or both sides of the head and neck. It is actually this neuralgia, or nerve inflammation that is sending distress signals back to the brain, complaining of the compression from the tight surrounding structures. The tension headache patient then experiences an array of symptoms resulting from these distress signals, ranging from head and neck pain, dizziness, photophobia, nausea, vomiting, and or other similar issues.

How can we provide relief from tension headaches?

Nerve decompression surgery, also called migraine surgery, is the procedure in which the GON, TON, and/or LON are released from the tension of the surrounding muscle tissue. This outpatient procedure has a greater than 90% success rate in providing long term improvement from the chronic pain and other symptoms of tension headache. The details of the surgical procedure can be found here. In this kind of headache surgery, small, well hidden incisions are used to access the the regions of concern, and the nerves are localized and released from the surrounding pressure. The nerves are often padded with a piece of adjacent fat to avoid further compression, and the new relaxed position of the nerve is without irritation from the surrounding muscles. Because the compression is released, the neuralgia subsides and the nerve returns to it’s normal state, no longer sending distress signals to the brain. Without the distress signals, the pain is not triggered, and the feedback circle of tight muscles that the pain was causing is no longer present. The entire loop of pain is broken and the tension headache is relieved.

Surgical treatment for tension headaches

When less invasive treatments fail to provide relief, it is crucial for tension headache sufferers to explore other options and be their own advocates to live a life free from unnecessary pain. Dr. Lowenstein sees many patients with chronic tension headaches, and is passionate about providing all his patients with the information they need to make an informed choice for themselves. Operating at the Migraine Surgery Specialty Center in Santa Barbara, CA, and also consulting out of the Migraine Surgery Speciality Center in Denver, CO, Dr. Lowenstein is dedicated to helping his patients improve their quality of living, by reducing the toll that prolonged periods of headaches can have on your life.

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