The Role of Occipital Artery Resection in the Surgical Treatment of Occipital Migraine Headaches

Abstract

Occipital artery resection significantly lowered the success of occipital migraine headache surgery. Greater occipital nerve decompression alone, without ligation of the occipital artery, significantly improved or eliminated occipital migraine headache in most patients. This suggests that routine removal of the occipital artery or its branches may not be necessary.

Targeting pericranial nerve branches to treat migraine: Current approaches and perspectives

“…More recently, the same group published several retrospective studies aiming at identifying predictors of favorable outcome (76,78,80) or added value of additional surgical procedures like supraorbital foraminotomy (79) or ligation of the occipital artery (81). Only three other groups have published retrospective studies on the effects of surgery in the frontal area in migraine.…”

Surgical Therapy of Migraine and Tension-Type Headache

“…According to some authors, the nerve arches medially to the semispinalis muscle, boring the fascial plane, while others describe it piercing the muscles themselves: the semispinalis in the vast majority of cases (90% of cases), the inferior oblique, or the trapezius [3,[5][6][7][8][9][10][11]. The latest studies have shown the exact location of the intramuscular course of the nerve: it is located 3 cm below and 1.5 cm lateral to the occipital protuberance [3,5]. The point of muscle penetration has a mean horizontal distance from the midline of 11 mm on the left and of 11.8 mm on the right.…”

“…It is composed of five layers: first the skin, very thick and adherent to the underlying planes; followed by a richly vascularized subcutaneous tissue, the muscular aponeurotic layer, composed of the posterior muscular bellies of the occipitalis muscle; the epicranial aponeurosis (galea aponeurotica); and then a loose areolar tissue, poor of connective tissue attachments; its laxity allows the scalp to slide on the skull and justifies the ease of surgical dissection in this area. Moreover, it is possible to create flaps without risk of damaging vessels and nerves, since these structures run in the superficial fascia [3,5,6].…”

“…This is due to the presence of muscular and fascial entrapments and also because of their interaction with the vascular structures [3,5,6,[12][13][14][15].…”

“…The direct and indirect cost due to MH treatment accounts for $13 to $17 billion each year only in the USA [2]. Every year 112 million workdays are missed because of MH, with a $14 billion annual loss of productivity in the USA [3]. MH has an even greater burden on patients' everyday life, their families, and the society.…”