Nerve Decompression Houston
Headaches affect almost 45 million people in the United States each year, and is one of the most common complaints seen at doctor’s offices. One in six people in United States suffers from headaches regularly. For some, headaches may be so severe they limit one’s ability to function normally.
It is believed that some headaches are triggered by excessive stimulation of the nerves which give sensation to the scalp and face. Irritation of these nerves is thought to cause the release of inflammatory substances that begin a cascade of events that lead severe headaches. Over the past 10 years, clinical research has shown that freeing the nerves at key points around the head and face (“trigger points”) will deactivate them and partially or totally alleviate the headaches.
History of headache surgery
For decades, ENTs (ear nose and throat surgeons) have seen relief from headaches after sinus and nasal surgery. In some patients sinus infections may cause pressure and lead to headaches. In others, a crooked septum (the middle part of the nose) may have contact with the turbinate (on the side of the nose) and this aggravates the nerve endings and causes severe pain and headaches. Nose and sinus surgery can improve breathing and reduce some types of headaches.
In the early 2000s a plastic surgeon named Dr Bahman Guyron found that browlifts, which release the muscle and nerves of the forehead for a cosmetic result also reduced headaches. Many studies have been done by his group and by other doctors across the world which showed the same results. Surgeons have also started doing surgery to release nerves from the back of the head (greater and lesser occipital nerves) to give relief from headaches that start at the neck/back of the head. As we move forward, more and more evidence is proving that releasing nerves from scarred muscle and fascia alleviates headaches in properly selected patients.
Dr Rodman has training in both ENT and facial plastic surgery, and is able to offer a comprehensive evaluation of sinus, nose and trigger point headaches. Her unique background in ENT and craniofacial surgery gives her extensive experience in nerve decompression surgery as well as sinus and nasal surgery.
Who is a candidate for surgery?
- Anyone who has been evaluated by a primary care doctor or headache specialist (such as a neurologist or pain specialist) and diagnosed with trigger point headaches, migraines, or occipital neuralgia**
- Patients who have headaches at least 4 days per week, and may have persistent ache on non headache days
- Pain may range from mild to severe intensity
- Headaches present for more than 6 months
- Patients who are tired of taking headache medications, and those who experience headaches that interfere with their personal and professional lives
- Ideal candidates have severe headaches that seem to come from one or two points on the head or face and then spread (Trigger points)
- Patients who have a good response to Botox or nerve blocks at trigger points
**For patients who have not seen a headache specialist, you are still welcome to come to our office for a consultation with Dr. Rodman. If further diagnostic evaluation or medical therapy is needed, she will be able to recommend you to another member of the headache team who can help you to begin to feel better.
Trigger Points and Types of Surgery
If you have severe headaches, Dr. Rodman will review your headache history and help determine whether surgery is an option for you. Common trigger points that can be treated with surgery are:
Occipital/ Back of head
Patients with these headaches generally feel like the headache starts in the back of the head and then radiates to the front or sides. Patients with these headaches often have a history of neck injury, whiplash, or neck muscle muscle tightness. Patients may have:
- Spasm or tightness in the muscles in the back of the neck
- Worsening of pain with engagement of neck muscles
- Tenderness at the back of the head
These headaches feel as though they start right above the eye or between the eyebrows.
Patients with these headaches may have:
- Strong corrugator muscles and deep vertical lines between the eyebrows (11 lines)
- Headaches worsening with squinting or concentrating
Pain in the temporal region is most commonly caused by occipital pain radiating up to this area. However, some rare patients may have headaches that originate primarily from the temples.
Patients with these headaches may have:
- Pain originating from point in the mid temple right at hairline
Patient often feel headaches from a contact point in the nose as pain behind the eyes. It may feel like a deep pain behind or below the eyes.
Patients may have:
- Worsening headaches with allergies or nose irritation
- Headaches worse in the morning or when lying down
How does it work?
During these procedures, Dr. Rodman will release the nerves that are irritated from the surrounding muscles and use your own fat to provide cushioning around the nerves. The surgery is performed in an outpatient operating room and patients go home the same day. Surgery lasts anywhere from 2-5 hours, depending on the procedures which are necessary. All the incisions are hidden within the hair or the creases of the eyelids, and are difficult to see once they are healed. Nasal surgery is done through an incision in the nose, and leaves no visible incisions.
What are the risks?
All surgical procedures have risk, however headache surgery risks are minimal. Most patients can expect some numbness, tingling or itching after the procedure. In most cases this will resolve in a few months, but in rare cases this may be permanent. There is a small chance of bleeding, excess scarring or infection. Serious or life threatening complications are very rare.
How successful is surgery?
Studies have shown that migraine surgery is successful in approximately 90% of patients. Success is defined as at least a 50% reduction in migraine headache frequency, intensity, or duration. However, as our experience grows, more and more patients are having complete relief of their symptoms.
What is the recovery time?
You will go home after a short recovery in the surgical recovery area. You will have small drain tubes beneath the skin that are removed in the first 2-4 days. There will be some swelling and bruising that lasts approximately 10 days. After about 2 weeks, you can resume normal social activities, but should refrain from heavy exercise for about a month.
Is it covered by insurance?
Evidence supporting the surgery is growing all the time, and some insurance companies do cover the procedure. Unfortunately this procedure is still considered experimental and other insurance companies may not cover the procedure. The best way to find out if your insurance covers headache surgery is to call your provider.
What should I expect at my consultation with Dr Rodman?
It is important that Dr. Rodman have all information about your previous headache treatements. Bring:
- All reports and CDs from MRI, CT scans or other imaging.
- A list of all the medications you currently take and all that you have tried in the past
You will be asked to complete a migraine questionnaire before your visit, which you can download here.
We also ask that you fill out the headache disability form and the function nose information form.
It is also helpful to keep a headache diary. This can be your own form of documenting, or you can download one here.
Dr. Rodman will discuss your headache history and perform a physical exam. This will include testing for trigger points and areas of tenderness around the face, head and neck. Dr. Rodman will also look in the nose with a small camera to evaluate for a contact point.
Based on your consultation, Dr. Rodman will work with you to find the best treatment for you and how to alleviate your headache pain.