Chronic Headache

Nerve decompression surgery for Chronic Daily Headache

Headaches are common once in a while in the daily modern life. Many times it is only a temporary pain due to the stress of the journey. Unfortunately for at least 10% of population, these headaches are more frequent than once in a while. Migraine is a neurological disease characterized for recurrent headaches that can go from moderate to severe pain episodes. Experiencing severe headaches more than two times per month might be sign to visit your doctor. Suffering a headache a day for more than fifteen days per month over a three-month period can be considered Chronic Migraine or chronic daily headaches. For a better diagnosis, it is important to identify the possible triggers that are activating the chronic headaches. These may include food, sleep deprivation, or hormones.

Surgery, procedures, and target nerves

Migraines are normally treated with a combination of painkillers with other more specific drugs such as topiramate (used as an anticonvulsant) or propranolol (used to treat high blood pressure). Nevertheless, there is no medication proved to be 100% effective in all migraine cases.

Surgery is a procedure that can be a more definitive solution for headaches, although it might not apply to all cases. Nerve decompression surgery is applied in different nerves according to the patient characteristics.

A neurologist must first diagnose candidate patients to surgery.  There is an evaluation to identify the site(s) where headache is activated. The medical background, such as headache duration and intensity, medication success or failure, medication side effects, is considered to determine the patient suitability for surgery.

Nerve decompression surgery is normally performed under general anesthesia and it takes one or two hours. If the patient have more than one triggering site, surgery may take longer. The procedure is not intracranial surgery, which means that the skull bones are never pierced or removed.

The target nerves to treat frontal migraines are the supraorbital and supratrochlear nerves. To decompress these nerves it is used an endoscopic approach (through the scalp) or a transpalpebral approach (upper eyelid).

The next most common nerve is the greater occipital nerve localized at the back of the scalp. From this nerve, there are at least six different points to decompress including the trapezius, semispinalis capitis, and the occipital artery. Other nerves are the zygomatico frontal and the auriculotemporal.

In cases of patients with rhinogenic migraines, headaches are caused by the irritation of the trigeminal nerve in the nasal mucosa. In this case, improvement can be done by septoplasty (correcting a deviated nasal septum), or a turbinectomy (when some or all of the turbinate bones are removed)



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