Pain coming from the occipital nerve (occipital neuralgia) is a very disabling disorder that is marked by fairly severe headaches coming from the back of the head forward. I personally know several very good physicians with this problem and they often have to miss work and take a lot of pain and headache medications for intermittent partial relief.
The diagnosis of occipital neuralgia can be confirmed by point tenderness over the occipital nerves and complete elimination of headaches by either a local anesthetic injection (24 hour relief) or Botox (several months relief). While many different treatments have been tried and used, none has proven to have a high degree of pain relief that is sustained.
Surgical decompression of the occipital nerve (neurolysis) has been a promising treatment that is directed toward muscular resection around the emerging greater occipital nerves. In the May 2009 issue of thw journal Plastic and Reconstructive Surgery, a paper was published on the largest series ever reported of the outcomes of this approach. In 206 consecutive patients, they analyzed the effects of greater and/or lesser occipital nerve neurolysis. The authors found that 80% of patients experienced at least 50% pain relief and 43% of patients experienced complete relief of all headaches at one year or greater after surgery. They only experienced two minor wound infection complications.
These substantial data support the concept that neurolysis of the greater occipital nerves can provides a safe, effective, and sustainable method of pain relief for those patients crippled with chronic headaches coming from this nerve source. Patients should first be evauated by a neurologist to rule out any other source for the headaches and have been through 6 months of non-surgical treatments to ensure that other approaches are not effective.
Dr. Barry Eppley