Surgical Treatment of Headaches, Migraines and Neuralgia

01 Sep Surgical Treatment of Headaches, Migraines and Neuralgia

I have worked with several thousand patients who have suffered from frontal, temporal or occipital neuralgia related chronic migraine headaches with outpatient surgical procedures. While some of the patients have had partial but significant relief after the surgeries, most of these patients who have suffered from long-standing and disabling headaches have experienced complete cure following surgery. However, some patients are unfortunately found not to be good surgical candidates.

Critical information:

• It is critical to understand that there are patients with a true migraine and true neuralgia related headache. It also should be kept in mind that there are those with overlapping symptoms of both, too.
• It is also very important that before they are seen by me, these patients have had a proper diagnostic workup, and are being medically treated by either a neurologist or a similar specialist who is experienced in headache treatment.

This will then ensure that other possible causes of headaches are excluded. It is also important that a potential surgical candidate receives nerve blocks or alternatively Botox in order 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. The most favorable candidates for surgical evaluation are those patients who continuously experience headaches or migraines, even though they are provided with optimal medical care from a specialist, and those who have tenderness over the involved nerves with temporary relief from nerve blocks and/or Botox.

Distinguishing headaches, migraines and neuralgia:

A migraine is not exactly a headache but rather a common type. Migraines are accompanied by symptoms such as nausea, vomiting or sensitivity to light where many people feel a kind of throbbing pain, felt on only one side of the head. A migraine is different than a tension headache. However, some people suffer from a mixture of a migraine and tension headaches, known as tension-migraine headaches. An interesting point to note down is that some people have an aura, a sort of a forewarning before an actual migraine begins. An aura is a group of symptoms such as vision disturbances which act as a warning sign that a headache is coming.

Many patients spend years searching for an effective treatment for migraines and neuralgias as their causes are very complicated. Very often, patients complain to us about how few providers are willing to hear them out and even fewer, if any at all, have tried to help solve their problems with the causes of migraines. Surgical treatment may be the best option to treat migraines for the patients whose other attempted treatments have failed.

Who’s affected and when is surgery required?

Statistics show that 28 million Americans above the age of 12 suffer from migraines and at least one in four households one member suffers from migraines. Headaches are the 3rd most common factors that lead to school absence and migraines are the most common cause. Migraines affect 5% of children and 10% of the adults. These issues occur due to the lack of FDA approved drugs for pediatric migraine PT’s and the number of children still with migraines/HA’s despite optimized medical treatment.

Occipital Neuralgia is the headache pain that occurs on the back of the head. It is a constant and occipital pain to the vertex, fronto-temporal lobe or periorbital areas. Occipital neuralgia has two types; unilateral and bilateral. There is no specific age range or sex dominance for it and can be present alone or even be accompanied by other headaches or migraine forms.

Fronto-temporal neuralgia is a headache that occurs on the front of the head and on the sides too. Similar to the occipital neuralgia, it has no specific age range. It may be present with dental malocussion, vision, sinus, TMJ and/or deviated septum. They can either occur alone or even be accompanied by migraines and headaches.

Chronic migraine headaches are episodic headaches that occur for 4 to 27 hours. It can also be chronic if it lasts for less than 15 days per month for at least 3 months. It can also be accompanied by occipital neuralgia or fronto-temporal neuralgia.