Abnormal Tissue Structure in Patients Undergoing Greater Occipital Nerve Decompression Surgery

Young woman touching bridge of nose to relieve headache while resting in bed.
Patients with migraine, headache, or occipital neuralgia who underwent greater occipital nerve decompression surgery had abnormal tissue structure.

Patients with occipital neuralgia, migraine, or headache who underwent greater occipital nerve decompression surgery had abnormal tissue structures, according to study results published in Plastic and Reconstructive Surgery.

This was an observational study in which study researchers prospectively enrolled patients (N=92) who presented at the Massachusetts General Hospital with chronic occipital neuralgia, headache, or migraine. Patients underwent trigger-site deactivation surgery at the occipital site. At 3 months, 1 year, and every year following, study researchers asked patients to complete the postoperative Migraine Headache Index (MHI) questionnaire and the Pain Self-Efficacy Questionnaire (PSEQ).

Patients were mostly women (n=71), with a mean age at surgery of 44.8 (standard deviation [SD], ±13.2) years, preoperative MHI scores of 110.8 (SD, ±89), and preoperative PSEQ scores of 17.2 (SD, ±11.8).

At 12 months, MHI scores improved to a mean of 34.2 (SD, ±65.6; P <.001), in which 70% of patients reported an average 96.3% improvement. The PSEQ improved to 35.3 (SD, ±18.7; P <.001) at follow-up.

During surgery, fibrotic and thick trapezius fascia (>3 mm) was observed in 94% of patients. Additionally, the occipital artery interacted significantly with the greater occipital nerve in 88% of patients.

Fibrotic tissue at the muscle/fascia interface was encasing or compressing the nerve in 30% of patients. In these patients, the greater occipital nerve appeared abnormal, edematous, flattened, and discolored (with a yellow or brown segment). Among few patients (5%), lymph node presence was found at the nuchal ridge, which may have contributed to nerve compression.

This study was limited by the exclusion of a healthy control group with which to compare these intraoperative findings because healthy individuals are not candidates for such surgery. Furthermore, the evaluations presented in this study were subjective and future studies may choose to incorporate imaging analysis for a more robust study design.

The study authors concluded that the majority of patients undergoing greater occipital nerve decompression surgery for occipital neuralgia, headache, or migraine had thickened trapezius fascia at the occipital trigger site. They added, “This structural anomaly has resemblance to thickened fascial tissues seen in other nerve compression syndromes, and could be related to microtrauma/overuse or actual trauma in the head and neck region.”


Gfrerer L, Hansdorfer MA, Ortiz R, Chartier C, Nealon KP, Austen WG et al. Muscle Fascia Changes in Patients with Occipital Neuralgia, Headache, or Migraine. Plast. Reconstr Surg. 2021;147(1):176-180. doi:10.1097/PRS.0000000000007484