Occipital Neuralgia, Headache & Migraine

Up to 4.9 million Australians suffer from migraines, with nearly 1 in 4 households affected. Among them, 71% are women of which 86% are of working age. The 2018 Migraine in Australia Deloitte Access Economic Report estimates migraine-related costs at $35.7 billion annually, including direct treatment costs and indirect impacts on work productivity [1].

Neurologists diagnose and treat migraines with multiple medications and complementary treatments like massage, physical therapy, and acupuncture are also available and may help. However, up to a third of migraine patients do not achieve full relief from these traditional methods.

When to explore other reasons for your headache:

A common underlying issue for many chronic migraine and headache sufferers is neuralgia. Irritation of peripheral nerves, located outside the brain and spinal cord (such as those in the scalp, forehead, or neck), may trigger irritation within the central nervous system, resulting in the perception and symptoms of headaches, including many associated with migraines. If this mechanism is indeed responsible, identifying and addressing the source of such compression could potentially alleviate headache symptoms.

For decades, plastic surgeons have been addressing nerve irritation and compression issues such as a common condition known as carpal tunnel syndrome. In this condition, a nerve in the wrist becomes compressed (i.e., squashed), and surgeons decompress it, thereby alleviating symptoms with a success rate around 90%. Substantial research now indicates that similar nerve compression can occur in the head and neck region. Decompression of these nerves can lead to significant or even complete and permanent relief from symptoms such as headaches.

When traditional methods have failed, we are often able to help. Many chronic headache patients suffer from nerve compression similar to conditions which peripheral nerve surgeons commonly treat in other parts of the body (e.g. carpal tunnel syndrome).

Common nerves that are involved in neuralgia related headache disorders include:

  • Greater Occipital Nerve (GON)

  • Lesser Occipital Nerve (LON)

  • Third Occipital Nerve (TON)

  • Supraorbital and Supratrochlear Nerves (SON and STN)

  • Auriculotemporal and Zygomaticotemporal Nerves (ATN and ZTN)

Lipi has a specialised interest in the diagnosis and treatment of neuralgia-associated migraines and headaches. She commences her approach with an in-depth patient history and physical examination, subsequently performing local anaesthetic blocks to pinpoint the compressed nerves. For certain patients, anatomically targeted Botulinum Toxin injections may also be beneficial. Those diagnosed with neuralgia might be candidates for surgical intervention, designed to decompress and release the affected nerves. Such surgeries are validated for their safety and effectiveness in multiple peer-reviewed journals. For those with extensive nerve damage, alternative surgical avenues might be explored.

Lipi has travelled overseas to undertake clinical observerships with pioneering surgeons in the field of headache deactivation surgery, often termed migraine decompression or occipital neuralgia decompression surgery. She has visited and trained with experts such as Dr. Bahman Guyuron, Dr. Ziv Peled, Dr. Gerald Austen, Dr. Lisa Gfrerer and Drs. Saja and Giorgio Pietramaggiori. Furthermore, she is a member of the Migraine Surgery Society.

If you believe neuralgia might be triggering your headaches or migraines, Dr. Lipi welcomes you to arrange a consultation.