The pain of a headache is something that nearly everyone can relate to and most people will experience headaches from time to time. For people who experience very severe or constant headaches, they may fall into the category of chronic migraine headache. By some estimates, as many as 35-45 million people in the US suffer from migraine headaches in some form. There are many different causes of headaches and most of these can be effectively treated with medication or lifestyle modifications.

For patients who have had a thorough workup by a headache specialist and have exhausted medical therapy, the cause of their headaches may be injury or compression of one or more peripheral nerves. Injury or compression to nerves in the back of the neck/head (greater occipital nerves, lesser occipital nerve, third occipital nerves) or in the front of the face by the eyes (supratrochlear, supraorbital, zygomaticotemporal nerves) are a common, and severely under-recognized cause of chronic headaches.

Chronic migraine-type headaches are especially likely to be due to some type of underlying peripheral nerve pathology if there is a history of trauma or injury to the head or neck area prior to the onset of the headaches. One of the most common types of injury mechanism that can lead to the development of these types of chronic headaches is a whip-lash injury to the neck. This can produce stretch-traction injuries to nerves and injuries to neck muscles which can lead to scarring and compression of nerves in the neck and base of the skull. When this happens, the patient will often experience constant, severe posterior headaches. Blunt or penetrating trauma to the face, back of the head or neck can also lead to nerve injury and chronic headaches.

Whether a history of trauma is present or not prior to the onset of the headaches, peripheral nerve injury as the source of the pain can be effectively ruled in or out by simply injecting local anesthetic around the suspects nerves and putting them to sleep. If the patient’s headache is relieved by numbing up the involved nerves, then it confirms peripheral nerve pathology as the true source of the headache pain. For these patients, surgery to decompress pinched nerves or sometimes disconnect damaged nerves can be very effective at relieving their chronic headache pain.