Chronic Headache, Migraine, Neuralgia

Chronic Headache, Migraine, Occipital Neuralgia, Fronto-temporal Neuralgia in the Distribution of Trigeminal Nerve Branches, Chronic Post-Traumatic Headache, Chronic Post-Operative Headache, Post-Herpetic Neuralgia, Post-Concussion Sports Injury Related Chronic Headaches: With outpatient surgical procedures I have helped over a thousand patients who suffered from frontal, temporal or occipital neuralgia related chronic migraine headaches. Most of these patients who have suffered from long standing and disabling headaches have experienced complete cure following surgery, while some have had partial but significant relief. Some patients are unfortunately found not to be good surgical candidates. It is important to understand that there are patients with true migraine, patients with a true neuralgia related headache and those with overlapping symptoms of both. Therefore, it is also important that these patients, prior to being seen by me, have had a proper diagnostic work-up, and are being medically treated by a neurologist or similar specialist experienced in headache treatment. This will ensure that other possible causes of headaches are excluded. It is important that a potential surgical candidate receive nerve blocks or alternatively Botox to confirm the involvement of occipital (greater>lesser) nerves or supraorbital/trochlear and/or zygomatico-temporal nerves as generators of occipital or fronto-temporal neuralgia related chronic headaches/migraines, respectively. Patients who continue to experience headaches/migraines despite optimal medical care provided by a headache specialist, and who have tenderness over the involved nerves with temporary relief from nerve blocks and/or Botox are optimal candidates surgical evaluation.

A migraine is a common type of headache that can occur with symptoms such as nausea, vomiting or sensitivity to light. In many people, the throbbing pain is felt on only one side of the head. A migraine is different than a tension headache, although some people suffer from mixed tension-migraine headaches, which have features of both a migraine and a tension headache.

Some people have an aura before the actual migraine begins. An aura is a group of symptoms, including vision disturbances, which act as a warning sign that a headache is coming.

The causes of migraines and neuralgias can be very complex and many patients spend years searching for an effective treatment. Too often patients tell us that few providers were willing to listen to them, and even fewer, if any, tried to help them solve the cause of their migraines. For many patients who have tried other treatments without success, surgical treatment may be the best option to treat their migraines.

Following this introduction, for the best educational experience that can help you define to what extent presented material applies to you, it is highly recommended that you follow, in order, next 4 steps/links:

  1. Watch 12 min lecture (link below)
  2. Visit “Peripheral Nerve Surgery for Chronic Headaches, Migraine, Neuralgia” link below (the same “Chronic Headaches, Migraine, Neuralgia” link you can access from “Procedures Performed” left column link),
  3. Visit “Patient Stories” link located at the left column, Home or Nerve Surgery page
  4. Go to “Patient Forms”, to complete “New Patient Questionnaire” and submit it to Dr. Ducic to help you define if surgical treatment is the appropriate choice for you.


Many patients find this 12-min lecture very informative, as it summarizes important points of my approach to the treatment of patients with post-concussion headaches, Post-whiplash or other related trauma headaches, fronto-temporal trigeminal neuralgia, occipital neuralgia, or other chronic migraine or headaches. Some of the information is updated in the meantime, as I gave that lecture few years ago, but the key components are daily used in my treatment approaches.

Peripheral Nerve Surgery for Chronic Headache, Migraine, or Neuralgia

There are patients with chronic migraines or neuralgias who do not find relief with medications or lifestyle changes. In these cases, peripheral nerve surgery may be the answer. Peripheral nerve surgery involves the surgeon determining which nerves are involved in generating the pain followed by surgically freeing-up the nerves (referred to as a neurolysis). This can reduce or even eliminate chronic headaches and migraines. If you have had nerve blocks or Botox injections which provided some relief, then the pain is most likely generated by peripheral nerves and can therefore be treated surgically.

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