Surgical deactivation of occipital migraine trigger site

BACKGROUND: Following the pioneering work of Guyuron et al. in 2001, an impressive body of literature demonstrated that the inflammation of peripheral nerves caused by chronic compression from surrounding structures (e.g., muscles, blood vessels) might trigger migraines. In this study, we report our experience with a minimally invasive surgical procedure for occipital migraine headache treatment. METHODS: From June 2011 until January 2019. we performed 246 MH decompression surgeries in patients with either frontal, occipital, or temporal migraine trigger sites. Among them, 130 surgeries were performed to treat occipital migraine (90 bilateral and 40 unilateral). In 108 occipital migraines, we found a dilated occipital artery in close connection with the greater occipital nerve (GON) and we ligated the vessel without any other surgical manoeuvres. RESULTS: After a mean follow-up of 21 months (range: 3-67 months), patients with occipital migraine had positive response in 94.9% (86.8% complete relief and 8.1% significant improvement). and 5.1% did not get any better. CONCLUSIONS: Occipital migraine is a common and debilitating condition that can be treated successfully with surgery. According to our experience, a dilated occipital artery is usually responsible for nerve compression, mostly the greater occipital nerve. Clinical outcome of our surgical procedure based on artery ligation seems to prove the validity of this hypothesis.