Surgical intervention (whether decompression or neurectomy/muscle implantation) for chronic headaches is performed as an outpatient procedure at an accredited surgery center or in the outpatient department of the California Pacific Medical Center. The procedures can last anywhere from 1 hour to 3 hours depending on the number and locations of the nerves being treated and what actually needs to be done with each individual nerve. This plan will be thoroughly discussed with you prior to your operation. There are relatively few restrictions following the procedure and discomfort is usually well tolerated with oral pain medication. The specific post-surgical instructions vary from case to case depending on the number of nerves treated and the manner in which they are treated (e.g. decompression vs. neurectomy). These instructions will also be thoroughly discussed with you prior to your scheduled operation.
It is important to understand that the final results with surgical intervention (and this is true of many nerve operations) may not be known for up to one year post-operatively as nerves can take a long time to recover. This point is especially true when the compression has been present for many years and the degree of compression has been severe. Happily, the results from these procedures are quite good. To date, over 90 peer-reviewed studies have been published that demonstrate the safety and efficacy of these operations. In one study out of Georgetown University, data from 190 patients with pain/headaches in the back of the head who underwent surgical decompression were analyzed. Over 80% of patients experienced at least 50% pain relief and over 43% of patients experienced complete relief of their headaches one year post-procedure! In February 2011, the five-year results of such procedures were published in the medical journal, Plastic and Reconstructive Surgery. These results demonstrated that five years following their operation, 88% of patients still reported greater than 50% improvement in their headache symptoms (frequency, severity and/or duration) and 29% were completely headache-free! There is even research demonstrating the cost-effectiveness of headache surgery for the health care system as a whole.
Proudly, I have also authored and co-authored several published articles that further delineate the compression topography of several nerves treated during headache surgery and even described a novel surgical approach to a commonly treated nerve. More recently, I had the honor of co-editing the second textbook ever published on the surgical treatment of chronic headaches and migraines. As a final point, the results from surgical intervention for chronic headache sufferers have been so profound, that the American Society of Plastic Surgeons put out a formal policy statement which says that these procedures are safe, effective and should be considered standard of care when more conventional modalities have failed.
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