Pathophysiology and Diagnosis of Nerve Compression Headache

  • Pamela BlakeEmail author


Compression of extracranial nerves may result in chronic, medically refractory headaches and neck pain. Recently discovered anatomic connections between the extracranial space and intracranial trigeminal pathways may provide a conduit by which the extracranial pathology of the sensory nerves of the face, scalp, and neck may lead to headaches that are often accompanied by migraine-like features of photophobia and nausea. Nerve compression headaches have a unique presentation that follows from the mechanism and pathophysiology of nerve compression, and the diagnosis may be made on the basis of careful history and the physical examination.


  1. 1.
    Bovim G, Fredriken TA, Stolt-Nielsen A, Sjaastad O. Neurolysis of the greater occipital nerve in cervicogenic headache. A follow-up study. Headache. 1992;32(4):175–9.CrossRefGoogle Scholar
  2. 2.
    Magnusson T, Ragnarsson T, Bjornsson A. Occipital nerve release in patients with whiplash trauma and occipital neuralgia. Headache. 1996;36(1):32–6.CrossRefGoogle Scholar
  3. 3.
    Guyuron B, Tucker T, Davis J. Surgical treatment of migraine headaches. Plast Reconstr Surg. 2002;109(7):2183–9.CrossRefGoogle Scholar
  4. 4.
    Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B. A review of current evidence in the surgical treatment of migraine headaches. Plast Reconstr Surg. 2014;134(4 Suppl 2):131S–41S.CrossRefGoogle Scholar
  5. 5.
    Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg. 2009;124(2):461–8.CrossRefGoogle Scholar
  6. 6.
    Mathew N. Pathophysiology of chronic migraine and mode of action of preventive medications. Headache. 2011;51s2:84–92.CrossRefGoogle Scholar
  7. 7.
    Dodick DW, Turkel CC, DeGryse RE, Aurora S, Silberstein SD, Lipton RB, Diener H-C, Brin MF. Onabotulinum toxin A for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50:921–36.CrossRefGoogle Scholar
  8. 8.
    Puledda F, Goadsby P. An update on non-pharmacological neuromodulation for the acute and preventive treatment of migraine. Headache. 2017;57(4):685–91.CrossRefGoogle Scholar
  9. 9.
    Goadsby PJ, Reutr U, Hallstron Y, Boressner G, Bonner JH, Zhang F, Sapra S, Picard S, Picard H, Mikol DD, Lenz RA. A controlled trial of Erenumab for episodic migraine. N Engl J Med. 2017;377(22):2123–32.CrossRefGoogle Scholar
  10. 10.
    Tepper S, Ashina M, Reuter U, Brandes JL, Dolezil D, Silberstein S, Winner P, Leonardi D, Mikol D, Lenz R. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomized, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2017;16(6):425–34.CrossRefGoogle Scholar
  11. 11.
    ICHD-3. Headache classification Committee for the International Headache Society (HIS) the international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.CrossRefGoogle Scholar
  12. 12.
    Cutrer FM. Pathophysiology of migraine. Semin Neurol. 2006;26(2):171.CrossRefGoogle Scholar
  13. 13.
    Diamond S, Bigal M, Silberstein S, Loder E, Reed M, Lipton R. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention Study. Headache. 2007;47(3):355–63.PubMedGoogle Scholar
  14. 14.
    Bigal ME, Serrano D, Buse D, Scher A, Steward W, Lipton R. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008;48:1157–68.CrossRefGoogle Scholar
  15. 15.
    Manack A, Buse DC, Serrano D, Turkel CC, Lipton RB. Rates, predictors and consequences of remission from chronic migraine to episodic migraine. Neurology. 2011;76:711–8.CrossRefGoogle Scholar
  16. 16.
    Scher A, Stewart W, Liberman J, Lipton R. Prevalence of headache in a population sample. Headache. 1998;38(7):497–506.CrossRefGoogle Scholar
  17. 17.
    Buse DC, Manack AN, Manning K, Serrano D, Reed ML, Turkel CC, Lipton RB. Chronic migraine prevalence, disability and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study. Headache. 2012;52(10):1456–70.CrossRefGoogle Scholar
  18. 18.
    GBD 2016 Neurological Disorders Collaborator Group. Global, regional and national burden of neurological disorders, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol. 2019;18:459–80.CrossRefGoogle Scholar
  19. 19.
    Hadjikhani N, Sanchez Del Rio M, Wu O, Schwartz D, Bakker D, Fischl B, Kwong KK, Cutrer FM, Rosen BR, Tootell RB, Sorensen AG, Moskowitz MA. Mechanisms of migraine aura revealed by functional MRI of the human visual cortex. Proc Natl Acad Sci U S A. 2001;98(8):4687–92.CrossRefGoogle Scholar
  20. 20.
    Kosaras B, Jakubowski M, Kainz V, Burstein R. Sensory innervation of the calvarial bones of the mouse. J Comp Neurol. 2009;515(3):331–48.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Schueler M, Messlinger K, Dux M, Neuhuber WL, De Col R. Extracranial projections of meningeal afferents and their impact on meningeal nociception and headache. Pain. 2013;154(9):1622–31.CrossRefGoogle Scholar
  22. 22.
    Schueler M, Neuhuber WL, De Col R, Messlinger K. Innervation of the rat and human dura mater and pericranial tissues in the parieto-temporal region by meningeal afferents. Headache. 2014;54:996–1009.CrossRefGoogle Scholar
  23. 23.
    Noseda R, Melo-Carrillo A, Nir RR, Strassman AM, Burstein R. Non-trigeminal nociceptive innervation of the posterior dura: implications to occipital headache. J Neurosci. 2019;39(10):1867–80.CrossRefGoogle Scholar
  24. 24.
    Perry CJ, Blake P, Buettner C, Papavassiliou E, Schain AJ, Bhasin MK, Burstein R. Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: implications for extracranial origin of headache. Ann Neurol. 2016;79(6):1000–13.CrossRefGoogle Scholar
  25. 25.
    Schmid AB, Coppieters MW, Ruitenberg MJ, McLachlan EM. Local and remote immune-mediated inflammation after mild peripheral nerve compression in rats. J Neuropathol Exp Neurol. 2013;72(7):662–80.CrossRefGoogle Scholar
  26. 26.
    Tang ZY, Shu B, Cui XJ, Zhou CJ, Shi Q, Holz J, Wang YJ. Changes of cervical dorsal root ganglia induced by compression injury and decompression procedure: a novel rat model of cervical radiculoneuropathy. J Neurotrauma. 2009;26(2):289–95.CrossRefGoogle Scholar
  27. 27.
    Berini SE, Spinner RJ, Jentoft ME, Engelstad JK, Staff NP, Suanprasert N, Dyck JB, Klein CJ. Chronic meralgia paresthetica and neurectomy: a clinical pathologic study. Neurology. 2014;82(17):1551–5.CrossRefGoogle Scholar
  28. 28.
    Blake P, Burstein R. Emerging evidence of occipital nerve compression in unremitting head and neck pain. J Headache Pain. 2019;20:76.CrossRefGoogle Scholar
  29. 29.
    Blake P, Rony-Reuven N, Perry CJ, Burstein R. Tracking patients with chronic occipital headache after occipital nerve decompression surgery: a case series. Cephalalgia. 2019;39(4):556–63.CrossRefGoogle Scholar
  30. 30.
    Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. A primate model for chronic nerve compression. J Reconstr Microsurg. 1985;1:185–95.CrossRefGoogle Scholar
  31. 31.
    Ganguly P, Brenhouse HC. Broken or maladaptive? Altered trajectories in neuroinflammation and behavior after early life adversity. Dev Cogn Neurosci. 2015;11:18–30.CrossRefGoogle Scholar
  32. 32.
    Anda R, Tietjen G, Schulman E, Felitti V, Croft J. Adverse childhood experience and frequent headaches in adults. Headache. 2010;50(9):1473–81.CrossRefGoogle Scholar
  33. 33.
    Janis JE, Barker JC, Palettas M. Targeted peripheral nerve-directed Onabotulinum toxin a injection for effective long-term therapy for migraine headache. Plast Reconstr Surg Glob Open. 2017;5(3):e1270.CrossRefGoogle Scholar
  34. 34.
    Stewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, Sawyer J. An international study to assess reliability of the migraine disability assessment (MIDAS) score. Neurology. 1999;53(5):988–94.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Headache Center of River OaksHoustonUSA
  2. 2.Department of NeurologyUniversity of Texas Health Science Center at Houston, Memorial Hermann Greater Heights HospitalHoustonUSA

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