Back to 2025 Abstracts
Early surgical decompression outperforms delayed intervention in pediatric onset occipital neuralgia
Matthew A. DePamphilis
*1, Charles D. Hwang
1, Katya Remy
1, Giulia L. Mönnink
2, Shirley Shue
1, Lisa Gfrerer
2, William G. Austen
11Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA; 2Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY
Background Occipital neuralgia is a tenacious headache disorder with an average delay of 20 years from symptom onset to age of nerve decompression surgery. Characteristics of occipital neuralgia in pediatric patients as well as outcomes following nerve decompression surgery remain uninvestigated. Given the shared etiology of underlying compressive neuropathies, we hypothesize that early surgical decompression would yield improved outcomes in pediatric and adolescent patients compared to delayed intervention.
Methods A prospective cohort study was conducted on 1286 patients who were screened for nerve decompression surgery from 2011-2025. Demographics, 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 Of the 266 patients that underwent greater occipital nerve decompression, 84 (31.6%) patients reported onset before the age of 18. A total of 23 (27.4%) patients underwent nerve decompression prior to age 26 and 61 (72.6%) at age 26 or older. The difference in time between onset of occipital neuralgia and surgery between early and delayed intervention was a significant 25 years (p<0.001). At baseline, nerve pain frequency and duration were similar but occurred at greater intensity in the delayed group (8 vs 9, p=0.008). Following nerve decompression, median pain improvement was significantly greater in early intervention group (97% [75-100] vs 80% [20-90], p=0.017). The proportion of patients reporting 100% pain improvement was also significantly greater (39% vs. 16%, p=0.026) in early intervention groups. The mean postoperative follow-up was 23 months.
Conclusion Pediatric onset of occipital neuralgia is common and there is positive therapeutic benefit to both early and delayed nerve decompression. We present compelling evidence for prioritizing early diagnosis, including within pediatric and adolescent cohorts, and prompt surgical decompression for maximizing outcome.
