Baltimore Peripheral Nerve Surgeon Eric H. Williams MD Provides Surgical Solutions for Patients With Head and Neck Pain Caused by Migraines or Occipital Neuralgia
Consistent, severe pain in the head and neck region can bring daily life to a grinding halt. It can be shooting, blinding, throbbing, or electric—but no matter how you may specifically describe it, it’s terrible. Luckily, Baltimore peripheral nerve surgeon Dr. Eric H. Williams may be able to help you get relief.
How Nerve Issues Lead to Head and Neck Pain
Often, pain in the head or neck can be neurological. This means that it originates from issues related to the nerves or the nervous system.
A pinched or compressed nerve is a common cause of nerve-related head and neck pain. This can occur when a nerve gets squeezed or pinched, in a number of different potential areas. There are “central” causes of pain that come from the “central nervous system.” These include problems that start in the brain or spinal cord. Pain from the central nervous system can occur from:
- Problems within the skull, like tumors, abnormal blood vessels, or infections
- Problems affecting the spinal cord from medical illnesses
- Spinal cord or nerve root compression from a herniated disc, bone spur, or other structural issue within the spine or surrounding areas
There are also “peripheral” causes of head and neck neuropathic pain as well which occur from pinched or damaged nerves in the “peripheral nervous system” once the nerves have left the brain and spinal cord. These nerves could be injured by trauma or a surgical procedure, or compressed by blood vessels in various locations within the head and neck. Pain may continue even though the injury itself has healed because the nerves may continue to send pain signals to the brain.
Dr. Williams specifically focuses on the treatment of the “peripheral” component of the causes of head and neck pain. Dr. Williams would refer any patient with a primary “central” nervous system disease to a neurologist and or neurosurgeon specializing in intracranial and spinal pathology for further diagnosis and treatment.
What Nerve Pain in the Head and Neck Feels Like
Nerve pain in the head and neck can present with a variety of unpleasant sensations, depending on the specific nerves involved. The patients Dr. Williams sees often report:
- Shooting or stabbing pain. Many people report sudden, sharp, and intense bursts of pain that feel like an electric shock or a lightning bolt shooting through the affected area.
- Burning or searing pain. The pain can sometimes feel like a constant, intense burning or searing sensation, almost as if the skin or tissues are on fire.
- Radiating pain. The pain may radiate or travel along the path of the affected nerve, potentially spreading from the neck into the head, face, shoulders, or arms.
- Numbness or tingling. In addition to pain, you may experience numbness, tingling, or a "pins and needles" sensation in the affected areas, indicating nerve compression or damage.
- Sensitivity to touch. Even light touch or pressure on the affected area can trigger or exacerbate the nerve pain, making it difficult to perform routine activities or find a comfortable position to rest.
The intensity and patterns of nerve pain in the head and neck can vary greatly. Some people experience constant, unrelenting pain, while others have intermittent flare-ups or episodes of intense pain followed by periods of relief. The pain may worsen with certain movements or activities that increase pressure on the affected nerves.
Surgical Treatment May Be an Option
Early diagnosis and proper management of neurological pain in the head or neck prevents further complications and improves your overall quality of life. Dr. Williams has extensive experience treating patients with migraines and occipital neuralgia via nerve decompression, release, and other procedures. (Get the information you need to prepare for your first visit.)
Surgery for Migraines
Migraine headaches affect millions of people every year. Some people may experience only one or two episodes per year, while others have one per month. There are some unfortunate individuals who may have headaches more often than not and can be nearly incapacitated with daily headaches.
Migraines can be treated in a variety of ways, including using prescription medications, electrical stimulation, and relaxation techniques such as mindfulness meditation, dietary changes, and avoiding common migraine triggers. However, when these conservative treatments fail to produce the desired results referral to a headache neurologist is very important so that a trained specialist can look closer at your personal situation.
At this point, specialized medications and injections may become necessary to gain long-lasting improvement. Oftentimes, this step is all patients will need to control their pain to a reasonable level. However, there are some patients out there who will continue to have refractory head and neck pain from neuropathic causes such as occipital neuralgia or chronic migraines that will not respond to standard therapy and who remain incapacitated by pain. These patients may best be served by surgical options if they qualify once a complete workup is performed.
Over the past 20 years, much progress has been made in understanding and recognizing peripheral nerve entrapments that may respond to targeted surgical intervention as the cause of chronic migraines and occipital neuralgia. Specific nerves that are compressed or damaged may lead to specific different patterns of pain. These triggers can be blocked temporarily with a nerve block to determine if a surgical procedure might be the best option for long-term treatment.
Dr. Williams often treats patients with frontal or temporal migraines. You can tell the difference between these two types of migraines by the area in which symptoms primarily occur.
- Frontal migraines. This type of migraine headache can be caused by compression or irritation of the supraorbital nerve and supratrochlear nerve branches of the ophthalmic division of the trigeminal nerve. These nerves transmit sensory information from the upper part of the face to the brain. If you have frontal migraines, pain and symptoms are primarily localized in the eyebrow and forehead region back to just behind the hairline.
- Temporal migraines. This type of migraine headache can be caused by compression of the auriculotemporal and/or zygomaticotemporal nerve branch of the maxillary divisions of the trigeminal nerve. The ATN and ZTN transmits sensory information from the lateral side of the head to the brain. If you have temporal migraines, pain and symptoms are focused on the side of the head above and just in front of your ears, otherwise known as the temple area.
Dr. Williams is a member of the The Migraine Surgical Society, which has been dedicated to educating not only surgeons but also primary care doctors, neurologists, and patients about the surgical management of severe refractory migraines.
Nerve decompression surgery for migraines has been proven to reduce or eliminate the frequency, duration, and severity of headache symptoms. Many of our patients, including a young woman we treated with a decompression of the right supraorbital nerve, find that they no longer need to take daily medications such as amitriptyline and Imitrex to manage their pain.
Surgery for Occipital Neuralgia
Occipital neuralgia is a type of headache disorder characterized by chronic pain that originates from the occipital nerves, which are located at the back of your head. There are two greater occipital nerves that travel from the upper neck, through muscles, through the back of the scalp, and toward the top of the head. In addition there are also two lesser occipital nerves and two third occipital nerves that complete the branches that provide sensation to the back of the head and neck. These nerves do overlap and communicate with each other, and if one is injured it is not uncommon to have injuries to others as well.
Any compression or damage along the course of these nerves can result in posterior head and neck pain. If these nerves are badly damaged or stretched, pain may be intermittent or continuous. An attack of pain may be stimulated by even the smallest, regular activities such as placing your head upon a pillow, brushing your hair, or just moving your neck the wrong way. In less severe cases, pain may only occur with heavier exertions such as sports or heavy lifting.
The exact cause of occipital neuralgia is often unclear, but it can result from injuries, muscle tightness, inflammation, or compression of the occipital nerves. Risk factors include trauma, whiplash, nerve irritation from arthritis in the upper spine, and severe strenuous exercise.
Conservative treatment options for occipital neuralgia include oral medications like anti-seizure drugs or tricyclic antidepressants, injections of steroids or anesthetic agents around the occipital nerves, and physical therapy. When these treatments fail to produce the desired results, occipital nerve decompression surgery may be recommended.
Dr. Williams has found that occipital nerve decompression surgery can produce impressive results in patients who’ve struggled with daily headaches for years. For example, one young athlete he treated developed post-traumatic occipital neuralgia after a sports injury. Decompression or nerve release of the greater occipital nerves along with removal or resection of the third and lesser occipital nerves improved her symptoms within a week of surgery. Five months after her operation, she reported near complete resolution of the pain that she was experiencing in the back of the head and neck.
