AUTHOR=Austen William G. , Remy Katya , Packowski Kathryn , Hazewinkel Merel H. J. , Gfrerer Lisa , Mathew Paul G. 

TITLE=Refractory occipital neuralgia treatment with nerve decompression surgery: a case series

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1284101

DOI=10.3389/fneur.2023.1284101

ISSN=1664-2295

ABSTRACT=The management of refractory occipital neuralgia (ON) can be challenging.Selection criteria for occipital nerve decompression surgery are not well defined in terms of clinical features and best preoperative medical management.Methods: 15 patients diagnosed with ON by a board certified, fellowship trained headache specialist and referred to a plastic surgeon for nerve decompression surgery were prospectively enrolled. All subjects received trials of occipital nerve blocks (NB), at least 3 preventive medications, and onabotulinum toxin (BTX) prior to surgery before referral to a plastic surgeon. Treatment outcomes included headache frequency (headache days/month), intensity (0-10), duration (hours), and response to medication/injectable therapies at 12 months postoperatively.Results: Preoperatively, median headache days/month was 30 (20-30), intensity 8 (8-10), and duration 24 hours (12-24). Patients trialed 10 (±5.8) NB and 11.7 (±9) BTX cycles.Postoperatively, headache frequency was 5 (0-16) days/month (p<0.01), intensity 4 (0-6) (p<0.01) and duration 10 (0-24) hours (p<0.01). Median patient-reported percent resolution of ON headaches was 80% (70-85%). All patients reported improvement of comorbid headache disorders, most commonly migraine, and a reduction, discontinuation, or increased effectiveness of medications, NB and BTX.All patients who underwent treatment for refractory ON by a headache specialist and plastic surgeon benefited from nerve decompression surgery in various degrees. The collaborative selection criteria employed in this study may be replicable in clinical practice.