Published June 25, 2021, Authored by Dr. Adam Lowenstein

The term “migraine surgery” was coined as a simplified way for the public to understand that there is a surgical procedure to improve migraine headache symptoms.  In fact, the more appropriate name for this procedure is “nerve decompression surgery for the relief of headache and migraine symptoms.”  That’s a bit too wordy, but unfortunately, the many different names of this operation can lead to misunderstanding.  “Migraine surgery,” “nerve decompression,” “occipital nerve decompression”, and “headache surgery” are all commonly used names for the same general procedure.

Doctors have long understood that nerve compression causes pain, and nerve decompression is a procedure used in many different parts of the body.  Ulnar nerve decompression at the wrist is also called carpel tunnel syndrome, and “carpal tunnel surgery” is the commonly used term for nerve decompression of the ulnar nerve in the wrist.  “Cubical tunnel surgery” is the common term for the release of the ulnar nerve at the elbow.  Many nerve decompression procedures are well-known operations that have proven, long-term results but are known but more “common” names.

As nerve decompression in the region of the eyebrow (the supraorbital and supratrochlear nerves) was originally noted to improve migraine headaches in the front of the head, the term “migraine surgery” was coined early on.  As we learned that decompression of the occipital nerves can cure occipital neuralgia and headaches in the back of the head and neck, the use of this nerve decompression surgery was expanded to the occipital nerves as well.  The term “migraine surgery” was also expanded to procedures for decompression of these nerves, since this compression of the occipital nerves can cause migraine headaches too.

Here things can be confusing for patients because occipital neuralgia is often confused with not only migraine headaches but also tension headaches and post-traumatic headaches.  The diagnosis of migraines originating in the back of the head vs tension headaches vs occipital neuralgia is quite ambiguous, and all three of these types of headaches are usually caused by compression of the occipital nerves.  

The surgical procedure to improve any headache is to release the nerves that are causing the headaches from the surrounding tissue that is irritating them.  Different headaches are caused by different nerve compressions and have a wide array of symptoms.  “Migraine headaches” are diagnosed by symptoms of pain, sometimes aura, sometimes nausea, etc, but the headaches arising from various nerve compressions may or may not have the symptoms that allow the “migraine” diagnosis.  The term migraine surgery is used for the release of the supraorbital, supratrochlear, OR the occipital nerves.  It’s the same name, though different nerves are addressed for different headaches and different symptoms.

But it gets even more complicated because sometimes there are other nerves involved.  Some headaches on the side of the head or the temples are caused by irritation and compression of either the auriculotemporal nerve or the zygomaticotemporal nerve, or both.  These nerves can also be addressed using nerve decompression surgery to improve headaches in these regions, also called temporal headaches.  Tension headaches can manifest in these areas as well, to confuse matters even further.  Because headaches in these areas often share the symptoms of migraine headaches, the nerve decompression surgery of these regions are also lumped into the term “migraine surgery.”

Want more confusion?  Let’s talk about headache diagnoses.  Chronic migraine, chronic daily headache, occipital neuralgia, tension headache, cluster headaches, and other headache types are all differentiated in diagnosis by the nature of their symptoms, the timing of their symptoms, and the frequency of their headaches.  But they all frequently stem from the same issue which is compression of these same nerves.  So if supraorbital nerve compression is causing a chronic daily headache, the surgery for improvement of the chronic daily headache should be called “chronic daily headache surgery”?  Or “nerve decompression surgery”?  Or “supraorbital nerve decompression”? Or “headache surgery”?  Tension headaches and post-traumatic headaches are so very often caused by compression of the occipital nerves.  What do we call the surgery that cures a patient’s post-traumatic headache?  In fact, the procedure is “nerve decompression of the occipital nerves”… but most commonly this too is known as “migraine surgery.”  

All of this can be so confusing for the headache patient that is just looking for pain relief.  A patient with tension headaches should not be put off by the term “migraine surgery,” and it is a shame that patients with tension headaches or post-traumatic headaches or even chronic daily headaches may miss out on permanent relief because they don’t Google “migraine surgery” to find the right specialist like Dr. Lowenstein.  

The nuances of headache diagnosis are unfortunately not related to the origin of the headache symptoms.  The origin of all different types of headaches is so often these nerves in the head and neck that can be addressed with minimally invasive, outpatient surgery that can provide permanent headache relief in so many cases.

So the take-away from this discussion should be that the terms “headache surgery”, “migraine surgery”, “occipital nerve decompression”, “occipital neuralgia surgery”, or “migraine surgery” are all terms for surgery that decompresses nerves in the head and neck known to cause headache symptoms and the additional symptoms of migraines.  Specialists in the outpatient, minimally invasive decompression of these nerves in the head and neck can provide long-term relief, and often cure of a wide array of headache diagnoses including migraine, tension headache, post-traumatic headache, and other headache syndromes.  If you are experiencing debilitating headache pain with any diagnosis,  contact a specialist like Dr. Lowenstein to learn about how nerve decompression can help you find headache relief.

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