As the surgical treatment of migraine headache evolves, plastic surgeons are learning that this modality actually represents a series of procedures designed to relieve pressure on specific peripheral nerves throughout the head and neck.
Occipital neuralgia or cervicalgia relates to occipital-generated headaches that stem from the greater (C2) and least (C3) occipital nerves. The occipital trigger sites are the most common trigger points of headache pain.
All patients presenting with chronic daily headaches should be evaluated by a neurologist or primary care physician who is familiar with International Headache Society guidelines for these disorders. Once this evaluation is complete, a thorough history focused on identifying peripheral nerve compression should be performed. The history should quantify the subjective complaints of pain by using the Migraine Disability Assessment Tool (MIDAS) or other reliable instruments such as the migraine headache index (MHI). Once the severity of disability has been stratified, it is important to ask where the pain consistently starts and radiates, whether there is a history of trauma such as whiplash, and if there are any previous cervical surgery/pathology and/or any other issues specific to the occipital region.