Patients with occipital neuralgia, migraines, or headaches who were exposed to more occipital nerve decompression exhibited abnormal tissue structures, according to the study results published in Plastic and Reconstructive Surgery.
This was an observational study in which study researchers prospectively enrolled patients (N = 92) who presented at Massachusetts General Hospital with chronic occipital neuralgia, headaches, or migraines. The patients underwent deactivation surgery on the back of the head. After 3 months, 1 year, and every year thereafter, the study researchers asked patients to complete the postoperative migraine headache index (MHI) questionnaire and the pain self-efficacy questionnaire (PSEQ).
The patients were predominantly women (n = 71) with a mean age at the operation of 44.8 (standard deviation) [SD]± 13.2) years, preoperative MHI values of 110.8 (SD, ± 89) and preoperative PSEQ values of 17.2 (SD, ± 11.8).
After 12 months, MHI scores improved to a mean of 34.2 (SD, ± 65.6; P <0.001), with 70% of patients reporting an average improvement of 96.3%. The PSEQ improved to 35.3 (SD, ± 18.7; P <0.001) at the follow-up examination.
A fibrotic and thick trapezoidal fascia (> 3 mm) was observed in 94% of patients during surgery. In addition, the occipital artery interacted significantly with the greater occipital nerve in 88% of patients.
Fibrotic tissue at the muscle-fascia interface enveloped or compressed the nerve in 30% of patients. In these patients, the greater occipital nerve appeared abnormal, edematous, flattened, and discolored (with a yellow or brown segment). In a few patients (5%), a lymph node presence was found on the neck crest, which may have contributed to nerve compression.
This study was limited by excluding a healthy control group to compare these intraoperative findings, since healthy individuals are not candidates for such an operation. In addition, the ratings presented in this study were subjective and future studies may choose to include imaging analysis for a more robust study design.
The study’s authors concluded that the majority of patients who had occipital nerve decompression surgery for occipital neuralgia, headaches, or migraines had thickened trapezoidal fascia at the occipital trigger site. They added, “This structural abnormality resembles thickened fascial tissue seen in other nerve compression syndromes and could be related to microtrauma / overuse or actual trauma to the head and neck.”
Gfrerer L., Hansdorfer MA, Ortiz R., Chartier C., Nealon KP, Austen WG et al. Changes in the muscle fascia in patients with occipital neuralgia, headache, or migraine. Plastic Reconstr Surg. 2021; 147 (1): 176-1. 180. doi: 10.1097 / PRS.0000000000007484