Surgical Management of Headache Disorders - A Systematic Review of the Literature

Mathew PG, Najib U, Khaled S, Krel R. Prevalence of Occipital Neuralgia at a Community Hospital-based Headache Clinic. Neurol Clin Pract. 2021;11(1).

Totonchi A, Pashmini N, Guyuron B. The zygomaticotemporal branch of the trigeminal nerve: an anatomical study. Plast Reconstr Surg. 2005;115(1).

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).

Chim H, Okada HC, Brown MS, Alleyne B, Liu MT, Zwiebel S et al. The auriculotemporal nerve in etiology of migraine headaches: Compression points and anatomical variations. Plast Reconstr Surg. 2012;130(2).

Kriegler Guyuronb. JS, Davis J, Amini SB. Five-Year Outcome of Surgical Treatment of Migraine Headaches. Plastic and reconstructive surgery (1963). 2011;127(2):603–8.

Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S. A placebo-controlled surgical trial of the treatment of migraine headaches. Plastic and reconstructive surgery (1963). 2009;124(2):461–8.

Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. www.covidence.org. Accessed 13 Dec 2023.

Raposio G, Raposio E. Principles and techniques of migraine surgery. Eur Rev Med Pharmacol Sci. 2022;26(17).

Raposio E, Simonacci F. Frontal trigger site deactivation for Migraine Surgical Therapy. Plast Reconstr Surg Glob Open. 2020;8(4).

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

•• Alizadeh K, Kreinces JB, Smiley A, Gachabayov M. Clinical Outcome of Nerve Decompression Surgery for Migraine Improves with Nerve Wrap. Plast Reconstr Surg Glob Open. 2021;9(10). The use of acellular dermal matrix nerve wraps improves surgical outcomes in headache surgery.

Li Y, Liu Z, Xu B, Jia H, Wang Y, Zhu Y et al. Surgical management of mucosal contact headache. Am J Otolaryngol - Head Neck Med Surg. 2022;43(2).

•• Knoedler L, Christian Chartier ME, Casari R, Ortiz J, Odenthal L, Gfrerer et al. Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery- A Prospective Cohort Study. Plastic and Reconstructive Surgery (1963) Publish Ahead of Print (2023). Nerve block response, specifically relative pain reduction and duration, serves as a valuable predictor of surgical outcomes in headache surgery.

Chung M, Lu KB, Sanniec K, Amirlak B. The Greater Occipital nerve and its dynamic Compression points: implications in migraine surgery. Plast Reconstr Surg. 2022;149(6).

• Gfrerer L, Lans J, Chartier C, Wenzinger E, Austen WG, Eberlin KR. Migraine Headaches in Patients with Upper Extremity Compressive Neuropathy. Plast Reconstr Surg. 2022;150(6). A correlation between upper extremity compressive neuropathies and patients with Headache Disorders has been found.

Long T, Ascha M, Guyuron B. Efficacy of Surgical Treatment of Migraine headaches Involving the Auriculotemporal nerve (site V). Plast Reconstr Surg. 2019;143(2).

Israel JS, Gutierrez-Meza D, Albano NJ, Smith JP, Abd-Elsayed A, Schwarze ML et al. Qualitative analysis of single-site headache surgery: is it different from multiple-site surgery? Ann Plast Surg. 2021;87(1).

•• Gfrerer L, Hansdorfer MA, Ortiz R, Chartier C, Nealon KP, Austen WG. Muscle Fascia Changes in Patients with Occipital Neuralgia, Headache, or Migraine. Plast Reconstr Surg. 2021;147(1). Patients undergoing greater occipital nerve decompression surgery have a high prevalence (94%) of thickened and fibrotic trapezius fascia, suggesting a structural anomaly that may be related to trauma in the head and neck region.

Torabi R, Bourn L, Veith J, Wisecarver I, Briley K, Bartow M et al. Population-Based Health Utility Assessment of Migraine headache symptoms before and after Surgical intervention. Plast Reconstr Surg. 2020;145(1).

Raposio G, Cortese K, Raposio E. An easy and reliable way to preoperatively identify the auriculo-temporal nerve in migraine surgery. Volume 75. Journal of Plastic, Reconstructive and Aesthetic Surgery; 2022.

Chim H. The scratch collapse test for diagnosis and treatment of trigger sites for migraine surgery. Plast Reconstr Surg Glob Open. 2022;10(2).

•• Rangwani SM, Hehr JC, Janis JE. Clinical effectiveness of peripheral nerve blocks for diagnosis of migraine trigger points. Plast Reconstr Surg. 2021;148(6). Nerve blocks show a high positive-predictive value of 0.89 in identifying surgical candidates for headache surgery.

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 Reconstr Surg Glob Open. 2019;7(4).

Shauly O, Gould DJ, Patel KM. Cost-utility analysis of surgical decompression relative to injection therapy for chronic migraine headaches. Aesthet Surg J. 2019;39(12).

Urhan N, Sağlam Y, Akkaya F, Sağlam O, Şahin H, Uraloğlu M. Long-term results of migraine surgery and the relationship between anatomical variations and pain. J Plast Reconstr Aesthetic Surg. 2023;82.

• Schoenbrunner A, Konschake M, Zwierzina M, Egro FM, Moriggl B, Janis JE. The Great Auricular Nerve Trigger Site: Anatomy, Compression Point Topography, and Treatment Options for Headache Pain. Plast Reconstr Surg. 2022;149(1). There are three possible points of compression of the great auricular nerve that could be addressed with nerve decompression surgery.

Chen ST, Schoenbrunner A, Gfrerer L, Packowski K, Austen WG, Janis JE. Estrogen-Associated headaches can be treated by surgery: a Multicenter Retrospective Cohort Study. Plast Reconstr Surg. 2022;150(4).

Blake P, Nir RR, Perry CJ, Burstein R. Tracking patients with chronic occipital headache after occipital nerve decompression surgery: a case series. Cephalalgia. 2019;39(4).

Hassan ElHawary K, Kavanagh JE, Janis. The positive and negative predictive value of targeted diagnostic botox injection in nerve decompression migraine surgery. Plastic & Reconstructive Surgery; 2023. p. 101097prs0000000000010806.

•• Gfrerer L, Xu W, Austen W, Ashina S, Melo-Carrillo A, Longhi MS et al. OnabotulinumtoxinA alters inflammatory gene expression and immune cells in chronic headache patients. Brain. 2022;145(7). Botulinum toxin primarily affects inflammatory gene expression in the periosteum of patients with chronic occipital headache.

Son BC. Decompression of the Greater Occipital nerve for Occipital Neuralgia and Chronic Occipital Headache caused by Entrapment of the Greater Occipital nerve. J Neurol Surg Cent Eur Neurosurg. 2022;83(5).

Zhu K, Ha M, Finkelstein ER, Chaudry S, Hricz N, Ngaage LM et al. The Surgical Management of migraines and Chronic headaches: a cross-sectional review of American Insurance Coverage. Ann Plast Surg. 2023;90(6).

• Yesantharao PS, Lee E, Klifto KM, Colakoglu S, Lee Dellon A, Reddy SK. A Markov Analysis of Surgical versus Medical Management of Chronic Migraines. In: Plastic and Reconstructive Surgery. 2022. Surgical decompression for refractory chronic migraine is more cost-effective than medical management.

Amirlak B, Lu KB, Erickson CR, Sanniec K, Totonchi A, Peled ZM et al. In-Depth look at the anatomical relationship of the lesser occipital nerve, great auricular nerve, and spinal accessory nerve and their implication in Safety of operations in the posterior triangle of the Neck. Plast Reconstr Surg. 2020;146(3).

Albano NJ, Israel JS, Carbullido MK, Stilp EK, Leverson G, Voils CI et al. Measuring Success in Headache Surgery: A Comparison of Different Outcomes Measures. Plast Reconstr Surg. 2023;151(3). Headache surgery is uniformly effective across various metrics, including the Migraine Headache Index and validated surveys.

Gfrerer L, Hansdorfer MA, Ortiz R, Nealon KP, Chartier C, Runyan GG et al. Patient pain sketches can predict surgical outcomes in trigger-site deactivation surgery for headaches. Plast Reconstr Surg. 2020.

• Casari ME, Chartier C, Gfrerer L, Austen WG. Evidence-Based Patient Selection in Headache Surgery: Impact of Preoperative Radiofrequency Ablation on Surgical Outcomes. Plast Reconstr Surg. 2023;151(5). Patients treated with radiofrequency ablation have a higher rate of macroscopic nerve damage that increases the risk of requiring reoperation.

Ortiz R, Gfrerer L, Hansdorfer MA, Nealon KP, Lans J, Austen WG. Migraine surgery at the frontal trigger site: an analysis of Intraoperative Anatomy. Plast Reconstr Surg. 2020;145(2).

Ortiz R, Gfrerer L, Hansdorfer MA, Tsui JM, Nealon KP, Austen WG. The efficacy of Surgical Treatment for headaches in patients with prior Head or Neck Trauma. Plast Reconstr Surg. 2020;146(2).

Afifi AM, Schwarze ML, Stilp EK, Orne J, Smith JP, Abd-Elsayed AA et al. Like a normal person again: a qualitative analysis of the impact of headache surgery. Plast Reconstr Surg. 2019;144(4).

Bajaj J, Doddamani R, Chandra S, Ratre S, Parihar V, Yadav Y et al. Comparison of Peripheral Neurectomy vs. Medical Treatment for Migraine: a Randomized Controlled Trial. Neurol India. 2021;69(7).

Lakshmanan S, Singh U, Zaffrullah NS, Manimaran V. Clinical outcome following endoscopic Septoturbinal surgeries for Rhinogenic Contact Point Headache: a retrospective analysis. Indian J Otolaryngol Head Neck Surg. 2022;74.

Ortiz R, Gfrerer L, Hansdorfer MA, Colona MR, Tsui JM, Austen WG. The Relationship of Psychiatric Comorbidities and Their Impact on Trigger Site Deactivation Surgery for Headaches. In: Plastic and Reconstructive Surgery. 2021.

•• Chartier C, Gfrerer L, Knoedler L, Austen WG. Artificial Intelligence-Enabled Evaluation of Pain Sketches to Predict Outcomes in Headache Surgery. Plast Reconstr Surg. 2023;151(2). This study introduces a machine learning algorithm that accurately predicts outcomes in headache surgery based on patient drawings, outperforming clinical evaluators.

Caviggioli F, Maione L, Vinci V, Lozito A, Tinterri C, Klinger M. Therapeutic Role of Fat Injection in the Treatment of Recalcitrant Migraine Headaches. Vol. 145, Plastic and Reconstructive Surgery. 2020.

Raposio G, Raposio E. Temporal surgery for chronic migraine treatment: a minimally-invasive perspective. Annals Med Surg. 2022;76.

Ertekin A, Yasar M. The effects of intervening with Synonasal Changes on headaches in Migraine patients using endonasal surgery. J Craniofac Surg. 2021;32(5).

Folic MM, Barac AM, Ugrinovic AB, Jotic AD, Trivic AS, Milovanovic JP et al. Effectiveness of the treatment of Rhinogenic Headache caused by Intranasal Contact. Ear Nose Throat J. 2023;102(9).

Altin F, Haci C, Alimoglu Y, Yilmaz S. Is septoplasty effective rhinogenic headache in patients with isolated contact point between inferior turbinate and septal spur? Am J Otolaryngol - Head Neck Med Surg. 2019;40(3).

Schoenbrunner AR, Khansa I, Janis JE. Cost-effectiveness of Long-Term, targeted OnabotulinumtoxinA versus peripheral trigger site deactivation surgery for the treatment of refractory migraine headaches. Plast Reconstr Surg. 2020;145(2).

Maniaci A, Lechien JR, Calvo-Henriquez C, Iannella G, Leigh S, Ingrassia A et al. Long-term stability of outcomes of endoscopic surgery for rhinogenic contact point headache (Sluder’’s neuralgia). Am J Otolaryngol - Head Neck Med Surg. 2022;43(2).

• Janis JE, Elhawary H, Schoenbrunner A, Salimi A, Packowski K, Kavanagh K et al. Revisiting the Role of Occipital Artery Resection in Greater Occipital Nerve Decompression. Plast Reconstr Surg. 2022;150(5). Occipital artery resection during greater occipital nerve decompression is safe and leads to improved outcomes.

Gfrerer L, Chartier C, Lans J, Eberlin KR, Austen WG. A correlation between upper extremity compressive neuropathy and nerve compression headache. Plast Reconstr Surg. 2021;148(6).

Ortiz R, Gfrerer L, Panzenbeck P, Hansdorfer MA, Austen WG. Trigger site deactivation surgery for headaches is Associated with decreased postoperative medication use. Plast Reconstr Surg Glob Open. 2021;9(6).

Gfrerer L, Lans J, Faulkner HR, Nota S, Bot AGJ, Austen WG. Ability to Cope with Pain Puts Migraine Surgery Patients in Perspective. In: Plastic and Reconstructive Surgery. 2018.

•• Pietramaggiori G, Scherer S. Minimally Invasive Nerve- and Muscle-Sparing Surgical Decompression for Occipital Neuralgia. Plast Reconstr Surg. 2023;151(1). This study introduces a minimally invasive, nerve- and muscle-sparing technique for surgical decompression of occipital nerves in patients with refractory occipital neuralgia.

Raposio G, Antonini A, Gualdi A, Raposio E. Frontal site surgery for chronic migraine therapy. Acta Biomed. 2023;94(6):e2023253. https://doi.org/10.23750/abm.v94i6.14777

Peled ZM, Gfrerer L, Hagan R, Al-Kassis S, Savvides G, Austen G, et al. Anatomic anomalies of the nerves treated during headache surgery. Plast Reconstr Surg Glob Open. 2023;11e5439. https://doi.org/10.1097/GOX.0000000000005439.

Hazewinkel MHJ, Remy K, Black G, Tseng S, Mathew PG, Schoenbrunner A, et al. Treatment Delay from onset of occipital neuralgia symptoms to treatment with nerve decompression surgery: a prospective cohort study. Pain Med. 2023;23:pnad154. https://doi.org/10.1093/pm/pnad154.

Janis JE, Hehr JHMKI, Gfrerer L, Kavanagh K, Blake P, Gokun Y et al. Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study. PRAS Open. 2023;(30;38:152–162. doi: 10.1016/j.jpra.2023.09.009

•• Hazewinkel MHJ, Remy K, Knoedler L, Tseng S, Schoenbrunner A. Treatment delay in patients undergoing headache surgery (nerve decompression surgery). JPRAS Open. 2023;38:226–36. 10.1016. Patients with headache disorders experience symptoms for an average of 20 years before undergoing surgery.

Austen WG Jr, Remy K, Packowski K, Hazewinkel MH, Gfrerer L, Mathew PG. Refractory occipital neuralgia treatment with nerve decompression surgery: a case series. Front Neurol. 2023;1284101. https://doi.org/10.3389/fneur.2023.1284101

• Wiberg A, Lucey MA, Kleeman S, Kang Y, Ng M, Furniss D. Genetic correlations between migraine and carpal tunnel syndrome. Plast Reconstr Surg. 2023; The study confirmed a genetic correlation between carpal tunnel syndrome and migraine in females, specifically implicating the TRIM32 gene locus as an area of shared genetic susceptibility.

Jiang D, Christ S, Correa-Gallegos D, Ramesh P, Kalgudde Gopal S, Wannemacher J et al. Injury triggers fascia fibroblast collective cell migration to drive scar formation through N-cadherin. Nat Commun. 2020;11(1).

Pietramaggiori G, Bastin A, Ricci F, Bassetto F, Scherer S. Minimally invasive nerve and artery sparing surgical approach for temporal migraines. JPRAS Open. 2023;2023;39:32–41. https://doi.org/10.1016/j.jpra.2023.11.005.

Gfrerer L, Dayan E, Austen WG. Trigger-site deactivation surgery for nerve compression headaches. Plast Reconstr Surg. 2021.

Kurlander DE, Ascha M, Sattar A, Guyuron B. In-Depth Review of Symptoms, Triggers, and Surgical Deactivation of Frontal Migraine Headaches (Site I). Vol. 138, Plastic and Reconstructive Surgery. 2016.

Kurlander DE, Punjabi A, Liu MT, Sattar A, Guyuron B. In-depth review of symptoms, triggers, and treatment of temporal migraine headaches (site II). Vol. 133, Plastic and Reconstructive Surgery. 2014.

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).

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).

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 Aesthetic Surg. 2013;66(10).

Olesen J. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Vol. 38, Cephalalgia. 2018.

Correa-Gallegos D, Jiang D, Christ S, Ramesh P, Ye H, Wannemacher J, et al. Patch repair of deep wounds by mobilized fascia. Nature. 2019;576:7786.

Coles MC, Buckley CD. Ready-made cellular plugs heal skin wounds. 576, Nature. 2019.

Perry CJ, Blake P, Buettner C, Papavassiliou E, Schain AJ, Bhasin MK et al. Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: implications for extracranial origin of headache. Ann Neurol. 2016;79(6).

Kosaras B, Jakubowski M, Kainz V, Burstein R. Sensory innervation of the calvarial bones of the mouse. J Comp Neurol. 2009;515(3).

Remy K, Raasveld FV, Saqr H, Khouri KS, Hwang CD, Austen WG Jr. et al. The Neuroma Map – A Systematic Review of the Anatomic Distribution, Etiologies and Surgical Treatment of Painful Traumatic Neuromas. Abstract. 2024.

Mathew PG, Cooper W. The diagnosis and management of Posttraumatic Headache with Associated painful cranial neuralgias: a review and Case Series. 25, Current Pain and Headache Reports. 2021.

Mathew PG, Najib U, Khaled S, Krel R. One and done: a Case Series of large volume occipital nerve blocks for the Treatment of Occipital Neuralgia (P5.10-007). Neurology. 2019;92(15_supplement).

Guyuron B, Riazi H, Long T, Wirtz E. Use of a doppler signal to confirm migraine headache trigger sites. Plast Reconstr Surg. 2015;135(4).

Gasparotti R, Garozzo D, Ferraresi S. Radiographic assessment of adult brachial plexus injuries. In: Practical Management of Pediatric and Adult Brachial Plexus Palsies. 2012.

Hwang L, Dessouky R, Xi Y, Amirlak B, Chhabra A. MR neurography of greater occipital nerve neuropathy: initial experience in patients with migraine. Am J Neuroradiol. 2017;38(11).

•• Kassis Salam. Migraine Surgery Candidate Selection with Magnetic Resonance Imaging. American Society for Peripheral Nerve (ASPN), Nassau, Bahamas. 2023; This study describes the application of MR Neurography to diagnose greater occipital nerve neuropathy in patients with occipital neuralgia.

Chhabra A, Bajaj G, Wadhwa V, Quadri RS, White J, Myers LL et al. MR neurographic evaluation of facial and neck pain: normal and abnormal craniospinal nerves below the skull base. Radiographics. 2018;38(5).

Merel HJ, Hazewinkel T, Li Y, Lin B, Cisse ET, Tan, Darryl B, Sneag et al. The use of MR Neurography in patients with neuromas of the head and neck region – a case series. Abstract. 2024.

Unglaub F, Hahn P, Spies CK. Iatrogenic nerve injuries prevalence, diagnosis and treatment. Volume 111. Deutsches Arzteblatt International; 2014.

Shaffrey EC, Seitz AJ, Albano NJ, Israel JS, Afifi AM. Expanding our role in Headache Management: a systematic review and Algorithmic Approach to Surgical Management of Postcraniotomy Headache. Ann Plast Surg. 2023;91(2).

Remy K, Hazewinkel MHJ, Mullen C, Hagan RR, Austen WG, Gfrerer L. Reoperation Following Primary Greater Occipital Nerve Decompression Surgery: Incidence, Risk Factors and Outcomes. Oral presentation at the American Society for Peripheral Nerve (ASPN). 2024, Nassau, Bahamas. 2024.

Langeveld M, Hundepool CA, Duraku LS, Power DM, Rajaratnam V, Zuidam JM. Surgical Treatment of Peripheral Nerve Neuromas: A Systematic Review and Meta-Analysis. Vol. 150, Plastic and Reconstructive Surgery. 2022.

Eberlin KR, Ducic I. Surgical algorithm for neuroma management: a changing treatment paradigm. Plast Reconstr Surg Glob Open. 2018;6(10).

• Gfrerer L, Wong FK, Hickle K, Eberlin KR, Valerio IL, Austen WG. RPNI, TMR, and Reset Neurectomy/Relocation Nerve Grafting after Nerve Transection in Headache Surgery. Plast Reconstr Surg Glob Open. 2022;10(3):e4201. https://journals.lww.com/10.1097/GOX.0000000000004201; Advanced nerve reconstruction techniques such as regenerative peripheral nerve interface and targeted muscle reinnervation show promise for preventing chronic pain and neuroma formation after greater occipital nerve transection.

•• Elhawary H, Barone N, Baradaran A, Janis JE. Efficacy and Safety of Migraine Surgery: A Systematic Review and Meta-analysis of Outcomes and Complication Rates. Ann Surg. 2022;275(2). Headache surgery is an effective and safe treatment option for refractory Headache Disorders, significantly reducing pain intensity, frequency, duration, with a low complication rate.

Haywood KL, Mars TS, Potter R, Patel S, Matharu M, Underwood M. Assessing the impact of headaches and the outcomes of treatment: A systematic review of patient-reported outcome measures (PROMs). Vol. 38, Cephalalgia. 2018.

Hazewinkel MHJ, Gfrerer L, Ashina S, Austen WGA, Klassen AF, Pusic A, et al. Readability analysis and concept mapping of PROMs used for headache disorders. Headache Published Online March. 2024 doi;25:101111head14706.

•• Kaur M, Tsangarias E, Hazewinkel MHJ, Ashina S, Austen WG, Klassen A et al. Development of a novel patient-reported outcome measure for headache disorder: the HEADACHE-Q. Plastic surgery the meeting 2023, Austin, TX. 2023. This study describes the first phase of the development of a novel, comprehensive, Patient-reported Outcome Measure For Headache Disorders.

Merel HJ, Hazewinkel K, Remy WG, Austen L. Gfrerer. The correlation between surgical treatment delay and surgical outcomes in headache surgery. Abstract. 2024.

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