Over the years, as I have operated on more and more patients with chronic headaches, my impression of this problem has changed somewhat. Time and again, I would see patients who had severe, frequent, long-lasting headaches who underwent surgery with me and did extremely well. Their headache frequency, severity and duration decreased significantly after their procedure and they were extremely happy. However, many patients still experienced severe headaches from time to time and the question that was posed to be on many occasions was, "What does it mean that I still have some severe headaches after surgery?" As I have talked with numerous such patients on many occasions and drilled down on their remaining symptoms and their treatment of these symptoms, an interesting observation occurred to me.
One obvious conclusion is that there are other trigger points that have yet to be treated surgically and were not detected prior to the operation in question. In some cases, operating on many trigger points is done in a staged manner on purpose because recovery after release of, for example, 16 different nerve trigger points throughout the head, neck and scalp would be a very prolonged and rather uncomfortable post-operative recovery process. In other cases, once the primary and most painful trigger were adequately treated, areas that were and remained less severely compressed and therefore less noticeable reared their ugly heads. In these instances the treatment was to work up these additional potential trigger points as I did the primary trigger points and treat them surgically if deemed necessary.
A second possibility also occurred to me quite some time ago as I spoke to patients about how they treated their residual headaches. There are a number of patients who have told me that pre-operatively they would take whatever preventative or abortive medication(s) they were prescribed by their treating physicians and that the medicine would work “approximately 50%” of the time. In other words flip a coin. Post-operatively, however, when these same patients experienced severe headaches, they found that the same medications almost always worked. I would hear this refrain over and over again and many a patient was puzzled by the change.
If you think about it, however, the answer actually makes perfect sense. I believe that some patients actually have a combination of mechanical compression over one or more nerves in addition to chemical imbalances within the brain that cause their headaches. Once a surgical procedure has treated the former, the latter is all that remains. Therefore, when a post-op patient experiences a severe headache that cannot be attributed to a persistently compressed nerve in another area, it could be secondary to a chemical imbalance. If that is true, then medication will help and explains why medication seems to be more effective after surgery, when needed. With this combination of treatment modalities, patients tell me on a consistent basis that their chronic headaches have gone from a debilitating to a very manageable problem.