Back to 2025 Abstracts

---

Differentiating nerve pain, headache and migraine: which of these conditions are we able to treat as surgeons?
Giulia Mönnink*², Matthew A. DePamphilis¹, Merel H. Hazewinkel², Kristyn A. Vicente², Jordan Raschi², Katya Remy¹, William G. Austen¹, Lisa Gfrerer^2
1Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, United States. ²Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, United States.

Background
Patients with neuropathic pain of the head and neck often experience concurrent headache disorders (HDs), particularly migraines and headaches, which may complicate diagnosis and treatment planning. We aimed to describe the clinical features of nerve pain, as well as concomitant HDs, and report on postoperative outcomes of these conditions following nerve decompression surgery.

Methods
From 2023-2025, 236 patients with a diagnosis of HD were prospectively enrolled at two institutions. Pain characteristics and accompanying symptoms were collected through patient surveys. The primary treatment outcome was evaluated by symptom reduction in terms of pain frequency (days/month), duration (hours/day), and intensity (0-10).

Results
In total, 178 (75.4%) patients reported nerve pain, 149 (63.1%) migraines, and 121 (51.3%) headaches. Of those with nerve pain, 152 (85.4%) were diagnosed with at least 1 concomitant HD. The average age of nerve pain onset was 35.8 +/-18.0 years, which was significantly later compared to both migraine (24.3 +/-13.3, p<0.001) and headache (26.8+/-18.2, p=0.002). Headache pain quality was more commonly classified as dull (n= 47 [38.9%], p=0.03) whereas nerve pain quality was typically described as shock-like (n= 77 [43.3%], p<0.001) or stabbing (n= 112 [62.9%], p<0.001). At baseline, nerve pain occurred at significantly greater mean frequency (23.4 +/-18.4 days/month, p<0.001) and duration (17.8 +/-19.5 hours/day, p=0.007) than migraines or headaches. Nerve decompression surgery was performed in 45 (19.1%) patients. Of these, 36 (80.0%) also experienced migraines and 26 (57.8%) headaches. Postoperatively, significant decreases in median pain frequency, duration and intensity were observed for nerve pain, migraine, and headaches (p<0.05). The mean postoperative follow-up was 8 months.

Conclusion
Although nerve decompression surgery is aimed at alleviating nerve pain, this study also demonstrates improvement in migraine and headache symptoms. These findings suggest that nerve compression/irritation may trigger and exacerbate concomitant HDs.