Chronic Headache, Migraine, and Whiplash
There are 180 different types of defined headaches.
Many people have headaches from time to time, but if you experience them on a daily or continual basis, your headaches may fall into the category of Chronic Migraine Headache.
30 million people in the US suffer from chronic migraines in some form. Many patients have centralized headaches that respond well to medicines. However, many people have headaches that are debilitating and don’t respond well to currently available pharmaceuticals.
It is estimated that up to 13 % (likely even higher) of all chronic headaches are related to occipital nerve neuralgia. Neuralgia is a general term for pain or irritation along the course of a nerve. We are addressing the irritation caused by nerve compression in this situation.
The Greater occipital nerve is the most commonly affected, but other nerves, like the lesser and dorsal (least) occipital nerves, can also be involved. Headaches may originate from the forehead or frontal region, involving the supra-orbital and zygomatico-temporal nerves.
If no underlying conditions are found, you may be a candidate for nerve decompression surgery, a short outpatient procedure that can significantly reduce or eliminate migraines. While some results are immediate, full effects may take weeks. Neuropax surgeons can evaluate if this surgery is right for you.
Studies have demonstrated that sensory nerve injury provides a substantial contribution to post-mastectomy pain. This is not surprising, given that multiple small sensory nerves are injured during breast surgery including mastectomy: the intercostal sensory nerves, the intercostobrachial nerve, and the supraclavicular nerve.
When breast tissue is surgically removed from the chest, sensory nerves traveling through these tissues are transected, stretched, or caught up in scar during the healing process. These nerve injuries can lead to chronic pain due to the development of what are known as end neuromas, neuromas-in-continuity, and scar compression. We have proven that the chronic pain is coming from these injured nerve(s).
Opioids, NSAIDs such as ibuprofen, and neuropathic drugs including gabapentin or amitriptyline are sometimes helpful in managing the pain to acceptable levels. However, these treatments are often insufficient due to incomplete pain relief, inconsistent administration, and adverse effects including chronic dependence (opioids), gastrointestinal distress (NSAIDs), and dizziness and fatigue (neuropathic drugs).
- Surgical Treatments of the Supraorbital and Supratrochlear nerves: Hagan R, Khansa I, Janis J. Chapter, Book, Surgical Treatment of Chronic Headaches and Migraines. March 2020. MS/FH
- Discussion: Efficacy of Surgical Treatment of Migraine Headaches Involving the Auriculotemporal Nerve (Site V). Brown DL: Plastic and Reconstructive Surgery 143(2): 564-565. MS/FH
- Supraorbital Rim Syndrome: Definition, Surgical Treatment, and Outcomes for Frontal Headache. Hagan RR, Fallucco MA, Janis JE, PRS Journal 2016. MS/FH
- A review of current evidence in the surgical treatment of migraine headaches. JanisJE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B. Plast Reconstr Surg. 2014 Oct;134(4 Suppl 2):131S-41S. doi: 10.1097 MS/FH
- Anatomy of the supratrochlear nerve: implications for the surgical treatment of migraine headaches. JanisJE, Hatef DA, Hagan R, Schaub T, Liu JH, Thakar H, Bolden KM, Heller JB, Kurkjian TJ. Plast Reconstr Surg. 2013 Apr;131(4):743-50. MS/FH
- The anatomical morphology of the supraorbital notch: Clinical relevance to the surgical treatment of migraine headaches; Fallucco M, Janis J, Hagan R, PRSJournal 2012. MS/FH
- Selective denervation of the corrugator supercilia muscle for the treatment of idiopathic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and supratrochlear dermatomes: Gualdi A, Camiaso-Daniel J, Gatti J, Peled Z, Hagan R, Bertossi D, Wurzer P, Kamolz LP, Scherer S, Pietramaggiori G. The journal of Headache and pain 22:9 (2021)
- The Greater Occipital Nerve and Obliquus Capitis Inferior Muscle: Anatomical Interactions and Implications for Occipital Pain Syndromes. Scherer SS, Schiraldi L, Sapino G, Cambiaso-Daniel J, Gualdi A, Peled ZM, Hagan R, Pietramaggiori G. PRS Journal 2019. Ch/WL
- Chronic daily headaches secondary to greater auricular and lesser occipital neuromas following endolymphatic shunt surgery; Vorobeichik L, Fallucco MA, Hagan RR, BMJ Case Reports 2012; doi: 1136/bcr-2012-007189. CH/WL
Nerve Decompression Surgery Can Reduce or End Your Migraine Headaches
The majority of patients with chronic pain report significant decreases or complete resolution of their pain. Most patients describe that the ‘nerve pain feelings’ are improved as soon as the following day. Discomfort from the operation is frequently described as a completely different sensation, which subsides in the next few weeks.