Nerve damage which may occur during traumatic brain injury (TBI) is a possible etiology for post-traumatic headaches.1 Based on this assumption, researchers at the Institute for Advanced Reconstruction, Shrewsbury, NJ, and UCLA Medical Center, CA, sought to determine the therapeutic benefits on post-traumatic headaches of surgical treatments usually indicated for peripheral neuropathy.
A neuropatholologic assessment of 15 patients (average age 41 yrs) who had undergone nerve decompression surgery to treat post-traumatic headache was presented at the 58th Annual Meeting of the American Headache Society in San Diego, CA.2
Study patients, all with prior head and neck trauma (average duration of symptoms 8 yrs) had shown responsiveness to nerve blocks, but not to other medical treatments, and did not present with radiographic abnormalities. A neuropathology assessment was conducted using the Migraine Disability Assessment (MIDAS) questionnaire in order to evaluate surgical outcomes.
Trigger points were occipital, temporal and supraorbital for 8 patients, occipital for 5 patients, and supraorbital for the remaining 2 patients. Surgical interventions included nerve wraps, neurolysis at trigger point sites and neurectomy at secondary nerve branches.
Surgical procedures revealed vascular and musculo-fascial compression. Pre-surgery MIDAS score was 230, and was improved by 79% following surgery. 6 of the patients had >80% improvements in headache symptoms, including 4 with MIDAS scores between 0-5, indicating near complete relief.
This study shows that nerve decompression surgery may benefit patients presenting with headaches as a result of trauma, due to associated post-inflammatory neuropathy.
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1.Defrin R. Chronic post-traumatic headache: clinical findings and possible mechanisms. J Man Manip Ther. 2014;22(1):36-44.
2.Kaufman MR, Jarrahy R. Abstract PS32. Nerve Decompression Surgery for Post-Traumatic Headache: A Report of Microsurgical Techniques, Intra-Operative Findings, and Surgical Outcomes. Presented at: 2016 American Headache Society Annual Meeting. June 9-12, 2016; San Diego, CA.