In clinical practice, nerve decompression surgery is not routinely considered as part of the management algorithm for occipital neuralgia (ON). The aim of this study is to evaluate the time between onset of ON symptoms and nerve decompression surgery.
Patients that were screened for pericranial nerve decompression surgery between September 2012 and November 2022 were prospectively enrolled. Patients with a diagnosis of ON were included. Among the patients whom underwent ON decompression surgery, pain frequency (pain days per month), -intensity (scale of 0-10), and duration (in hours) were recorded preoperatively and at 12 months post-operatively.
397 patients met the inclusion criteria. Patients were predominantly female (80%). The average age of pain onset was 24 (±15) years. After screening, 158 (40%) patients underwent occipital nerve decompression. The average time between onset of ON symptoms and nerve decompression surgery was 19 years (7.3-32). The average time of postoperative follow-up was 8.9 (± 4.2) months. Among the patients that underwent surgery, the median number of pain days per month decreased from 30 (25-30) preoperatively to 8.0 (0-30) (73%) (p<0.001) post-operatively, the median pain intensity decreased from 9.0 (8.0-10.0) preoperatively to 5.0 (0-7.0) (44%) (p<0.001) post-operatively and the median pain duration in hours decreased from 24 (10-24) preoperatively to 4.0 (0-12) (83%) (p<0.001) post-operatively.
The results of this study demonstrate that patients experience ON for an average of 19 years prior to undergoing nerve decompression surgery. Occipital nerve decompression significantly improves pain frequency, duration and pain in patients experiencing ON and should be considered earlier in the treatment course of patients with refractory ON.