Trigger Site Inactivation for the Surgical Therapy of Occipital Migraine and Tension-type Headache: Our Experience and Review of the Literature

Background: Literature from the last decade has shown a correlation between resection of the occipital muscles and vessels and relief from migraine and tension-type headaches.Methods: The aim of this article was to describe the authors' technique to treat occipital migraine, while comparing our approach with the other currently available surgical options. Relevant anatomical issues and their implications in the surgical treatment of occipital migraine have been reviewed. We undertook a modified version of the currently used method of occipital migraine surgery. Patients completed questionnaires before and after surgery, and results were compared.Results: To identify all trigger points, we used a constellation of symptoms referred to by the patient rather than injection of botulinum toxin type A. The entire procedure was carried out under local anesthesia. In most of the patients (56) in whom a dilated/aneurysmal occipital artery was found, the procedure was limited to ligation of the occipital artery, with no further undermining of muscles or neurolysis, which reduced the invasiveness of the procedure.Conclusions: The main differences between our procedure and the currently used method were that (1) extensive undermining and muscular or nerve resection were not necessary and (2) no flap was transposed with the purpose of covering isolated nerves. Hence, our method could improve the currently used method, while minimizing its invasiveness.