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Surgical Treatment of the Greater Occipital Nerve

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Surgical Treatment of Chronic Headaches and Migraines

Abstract

This chapter discusses all the steps that are required to perform successful nerve decompression surgery at the occipital trigger site. Evaluation and diagnosis of patients with occipital migraines/headaches/neuralgia is explained in detail with videos of neuromodulator/nerve block injection sites. Differential diagnoses are provided. Surgical anatomy and surgical techniques for nerve release are described and accompanied by video, figures, and illustrations. Outcomes at this site are summarized and potential complications are examined.

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References

  1. Guyuron B, Kriegler JS, Davis J, Amini SB. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg. 2005;115(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  2. BOTOX Prescribing Information. 2017. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/103000s5302lbl.pdf.

  3. Netter FH. Atlas of human anatomy. Toms River: Ciba-Geigy; 1989.

    Google Scholar 

  4. Moore KL. Clinically oriented anatomy. 3rd ed. Baltimore: Williams &Wilkins; 1992.

    Google Scholar 

  5. Grant JCB. An atlas of anatomy. 6th ed. Baltimore: Williams & Wilkins; 1972.

    Google Scholar 

  6. Mosser SW, Guyuron B, Janis JE, Rohrich RJ. The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches. Plast Reconstr Surg. 2004;113(2):693–7; discussion 8-700

    Article  PubMed  Google Scholar 

  7. Janis JE, Hatef DA, Ducic I, Reece EM, Hamawy AH, Becker S, et al. The anatomy of the greater occipital nerve: part II. Compression point topography. Plast Reconstr Surg. 2010;126(5):1563–72.

    Article  CAS  PubMed  Google Scholar 

  8. Janis JE, Hatef DA, Reece EM, McCluskey PD, Schaub TA, Guyuron B. Neurovascular compression of the greater occipital nerve: implications for migraine headaches. Plast Reconstr Surg. 2010;126(6):1996–2001.

    Article  CAS  PubMed  Google Scholar 

  9. Ducic I, Moriarty M, Al-Attar A. Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches. Plast Reconstr Surg. 2009;123(3):859–63; discussion 64

    Article  CAS  PubMed  Google Scholar 

  10. Junewicz A, Katira K, Guyuron B. Intraoperative anatomical variations during greater occipital nerve decompression. J Plast Reconstr Aesthet Surg. 2013;66(10):1340–5.

    Article  PubMed  Google Scholar 

  11. Dash KS, Janis JE, Guyuron B. The lesser and third occipital nerves and migraine headaches. Plast Reconstr Surg. 2005;115(6):1752–8; discussion 9-60

    Article  CAS  PubMed  Google Scholar 

  12. Lee M, Brown M, Chepla K, Okada H, Gatherwright J, Totonchi A, et al. An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches. Plast Reconstr Surg. 2013;132(6):1551–6.

    CAS  PubMed  Google Scholar 

  13. Peled ZM, Pietramaggiori G, Scherer S. Anatomic and compression topography of the lesser occipital nerve. Plast Reconstr Surg Glob Open. 2016;4(3):e639.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B. In-depth review of symptoms, triggers, and treatment of occipital migraine headaches (site IV). Plast Reconstr Surg. 2017;139(6):1333e–42e.

    Article  CAS  PubMed  Google Scholar 

  15. Ducic I, Felder JM 3rd, Khan N, Youn S. Greater occipital nerve excision for occipital neuralgia refractory to nerve decompression. Ann Plast Surg. 2014;72(2):184–7.

    Article  CAS  PubMed  Google Scholar 

  16. Ducic I, Hartmann EC, Larson EE. Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia. Plast Reconstr Surg. 2009;123(5):1453–61.

    Article  CAS  PubMed  Google Scholar 

  17. Gfrerer L, Maman DY, Tessler O, Austen WG Jr. Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes. Plast Reconstr Surg. 2014;134(4):771–8.

    Article  CAS  PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. Lee M, Lineberry K, Reed D, Guyuron B. The role of the third occipital nerve in surgical treatment of occipital migraine headaches. J Plast Reconstr Aesthet Surg. 2013;66(10):1335–9.

    Article  PubMed  Google Scholar 

  20. Israel JS, Kempton SJ, Afifi AM. Prospective analysis of the greater occipital nerve location in patients undergoing occipital nerve decompression. Ann Plast Surg. 2018;81(1):71–4.

    CAS  PubMed  Google Scholar 

  21. Scherer S, et al. The greater occipital nerve and obliquus capitis inferior muscle: anatomical INteractions and implications for occipital pain syndromes. Plast Reconstr Surg. 2019;144(3):730.

    Article  CAS  PubMed  Google Scholar 

  22. Ducic I, Felder JM 3rd, Janis JE. Occipital artery vasculitis not identified as a mechanism of occipital neuralgia-related chronic migraine headaches. Plast Reconstr Surg. 2011;128(4):908–12.

    Article  CAS  PubMed  Google Scholar 

  23. Gfrerer L, Hansdorfer M, Ortiz R, Nealon K, Austen WG. Occipital neuralgia/ migraine: Intra- operative evidence for extracranial pathology. American Society of Peripheral Nerve Meeting; 1–3 Feb 2019; Palm Desert, CA2018.

    Google Scholar 

  24. Alexander EP. History, physical examination, and differential diagnosis of neck pain. Phys Med Rehabil Clin N Am. 2011;22(3):383–93, vii

    Article  PubMed  Google Scholar 

  25. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284–99.

    Article  PubMed  Google Scholar 

  26. Pantaloni M, Sullivan P. Relevance of the lesser occipital nerve in facial rejuvenation surgery. Plast Reconstr Surg. 2000;105(7):2594–9; discussion 600–3.

    Article  CAS  PubMed  Google Scholar 

  27. Janis JE, Dhanik A, Howard JH. Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression. Plast Reconstr Surg. 2011;128(1):123–31.

    Article  CAS  PubMed  Google Scholar 

  28. Gfrerer L, Guyuron B. Surgical treatment of migraine headaches. Acta Neurol Belg. 2017;117(1):27–32.

    Article  PubMed  Google Scholar 

  29. Guyuron B, Nahabet E, Khansa I, Reed D, Janis JE. The current means for detection of migraine headache trigger sites. Plast Reconstr Surg. 2015;136(4):860–7.

    Article  CAS  PubMed  Google Scholar 

  30. Austad ED. Relevance of the lesser occipital nerve in facial rejuvenation surgery. Plast Reconstr Surg. 2000;105(7):2600–3.

    Article  PubMed  Google Scholar 

  31. Punjabi A, Brown M, Guyuron B. Emergence of secondary trigger sites after primary migraine surgery. Plast Reconstr Surg. 2016;137(4):712e–6e.

    Article  CAS  PubMed  Google Scholar 

  32. Guyuron B, Kriegler JS, Davis J, Amini SB. Five-year outcome of surgical treatment of migraine headaches. Plast Reconstr Surg. 2011;127(2):603–8.

    Article  CAS  PubMed  Google Scholar 

  33. Seyed Forootan NS, Lee M, Guyuron B. Migraine headache trigger site prevalence analysis of 2590 sites in 1010 patients. J Plast Reconstr Aesthet Surg. 2017;70(2):152–8.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Amirlak B, Sanniec K, Pezeshk R, Chung M. Anatomical regional targeted (ART) BOTOX injection technique: a novel paradigm for migraines and chronic headaches. Plast Reconstr Surg Glob Open. 2016;4(12):e1194.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lee M, Monson MA, Liu MT, Reed D, Guyuron B. Positive botulinum toxin type a response is a prognosticator for migraine surgery success. Plast Reconstr Surg. 2013;131(4):751–7.

    Article  CAS  PubMed  Google Scholar 

  37. Liu MT, Armijo BS, Guyuron B. A comparison of outcome of surgical treatment of migraine headaches using a constellation of symptoms versus botulinum toxin type A to identify the trigger sites. Plast Reconstr Surg. 2012;129(2):413–9.

    Article  CAS  PubMed  Google Scholar 

  38. Guyuron B, Tucker T, Davis J. Surgical treatment of migraine headaches. Plast Reconstr Surg. 2002;109(7):2183–9.

    Article  PubMed  Google Scholar 

  39. Zhang X, Strassman AM, Novack V, Brin MF, Burstein R. Extracranial injections of botulinum neurotoxin type A inhibit intracranial meningeal nociceptors’ responses to stimulation of TRPV1 and TRPA1 channels: are we getting closer to solving this puzzle? Cephalalgia. 2016;36(9):875–86.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zhang H, Yang X, Lin Y, Chen L, Ye H. The efficacy of greater occipital nerve block for the treatment of migraine: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;165:129–33.

    Article  PubMed  Google Scholar 

  41. Tang Y, Kang J, Zhang Y, Zhang X. Influence of greater occipital nerve block on pain severity in migraine patients: a systematic review and meta-analysis. Am J Emerg Med. 2017;35(11):1750–4.

    Article  PubMed  Google Scholar 

  42. Zhang Z, Dellon AL. Facial pain and headache associated with brachial plexus compression in the thoracic inlet. Microsurgery. 2008;28(5):347–50.

    Article  PubMed  Google Scholar 

  43. Buller LT, Jose J, Baraga M, Lesniak B. Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies. Am J Orthop (Belle Mead NJ). 2015;44(8):376–82.

    Google Scholar 

  44. van Alfen N, Malessy MJ. Diagnosis of brachial and lumbosacral plexus lesions. Handb Clin Neurol. 2013;115:293–310.

    Article  PubMed  Google Scholar 

  45. Elimairi I, Baur DA, Altay MA, Quereshy FA, Minisandram A. Eagle’s Syndrome. Head Neck Pathol. 2015;9(4):492–5.

    Article  PubMed  Google Scholar 

  46. Saccomanno S, Greco F, E DEC, Lucidi D, Deli R, D’Addona A, et al. Eagle’s Syndrome, from clinical presentation to diagnosis and surgical treatment: a case report. Acta Otorhinolaryngol Ital. 2018;38(2):166–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Afifi AM, Carbullido MK, Israel JS, Sanchez RJ, Albano NJ. Alternative approach for occipital headache surgery: the use of a transverse incision and “W” flaps. Plast Recontr Surg Global. 2019;7(4):e2176.

    Article  Google Scholar 

  48. Chmielewski L, Liu MT, Guyuron B. The role of occipital artery resection in the surgical treatment of occipital migraine headaches. Plast Reconstr Surg. 2013;131(3):351e–6e.

    Article  CAS  PubMed  Google Scholar 

  49. Guyuron B, Gatherwright J, Reed D, Ansari H, Knackstedt R. Treatment of dopplerable nummular headache with minimally invasive arterectomy under local anesthesia. J Plast Reconstr Aesthet Surg. 2018;71:1010.

    Article  PubMed  Google Scholar 

  50. Ducic I, Felder JM 3rd, Endara M. Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia. Headache. 2012;52(7):1136–45.

    Article  PubMed  Google Scholar 

  51. Ducic I, Larson EE. Posttraumatic headache: surgical management of supraorbital neuralgia. Plast Reconstr Surg. 2008;121(6):1943–8.

    Article  CAS  PubMed  Google Scholar 

  52. Ducic I, Sinkin JC, Crutchfield KE. Interdisciplinary treatment of post-concussion and post-traumatic headaches. Microsurgery. 2015;35(8):603–7.

    Article  PubMed  Google Scholar 

  53. Oh S, Tok S, Allemann J, Prevost A, Schmid UD. [Exeresis in occipital neuralgia]. Neurochirurgia (Stuttg). 1983;26(2):47–50.

    Google Scholar 

  54. Sharma RRDR, Pawar SJ, Mahapatra AK. Current status of peripheral neurectomy for occipital neuralgia. Neurosurg Q. 2005;15:232–8.

    Article  Google Scholar 

  55. Gfrerer L, Hulsen JH, McLeod MD, Wright EJ, Austen WG Jr. Migraine surgery: an all or nothing phenomenon? Prospective evaluation of surgical outcomes. Ann Surg. 2019;269(5):994–9.

    Article  PubMed  Google Scholar 

  56. Poggi JT, Grizzell BE, Helmer SD. Confirmation of surgical decompression to relieve migraine headaches. Plast Reconstr Surg. 2008;122(1):115–22; discussion 23–4.

    Article  CAS  PubMed  Google Scholar 

  57. Guyuron B, Harvey D, Reed D. A prospective randomized outcomes comparison of two temple migraine trigger site deactivation techniques. Plast Reconstr Surg. 2015;136(1):159–65.

    Article  CAS  PubMed  Google Scholar 

  58. Lin SH, Lin HC, Jeng CH, Hsieh CH, Lin YH, Chen CC. Experience of surgical treatment for occipital migraine in Taiwan. Ann Plast Surg. 2016;76(Suppl 1):S80–4.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Lisa Gfrerer

  2. Washington Nerve Institute, The George Washington University, McLean, VA, USA

    Ivica Ducic

  3. Department of Plastic Surgery, University Hospital Ohio State University, Wexner Medical Center, Columbus, OH, USA

    Jeffrey E. Janis

Authors
  1. Lisa Gfrerer
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  2. Ivica Ducic
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  3. Jeffrey E. Janis
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Corresponding author

Correspondence to Jeffrey E. Janis .

Editor information

Editors and Affiliations

  1. Associate Professor, Division of Plastic Surgery, University of Wisconsin - Madison, Madison, WI, USA

    Ahmed M. Afifi

  2. Plastic and Peripheral Nerve Surgeon, Peled Plastic Surgery, San Francisco, CA, USA

    Ziv M. Peled

  3. Professor of Plastic Surgery, Neurosurgery, Neurology, and Surgery Chief of Plastic Surgery, University Hospital Ohio State University, Wexner Medical Center, Columbus, OH, USA

    Jeffrey E. Janis

Electronic Supplementary Material

Greater occipital nerve injection (MP4 28063 kb)

Greater occipital nerve decompression (MP4 200121 kb)

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Gfrerer, L., Ducic, I., Janis, J.E. (2020). Surgical Treatment of the Greater Occipital Nerve. In: Afifi, A., Peled, Z., Janis, J. (eds) Surgical Treatment of Chronic Headaches and Migraines. Springer, Cham. https://doi.org/10.1007/978-3-030-36794-7_6

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  • DOI: https://doi.org/10.1007/978-3-030-36794-7_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-36793-0

  • Online ISBN: 978-3-030-36794-7

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