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The Role of Occipital Artery Resection in the Surgical Treatment of Occipital Migraine Headaches

Chmielewski, Lauren M.D.; Liu, Mengyuan T. B.S.; Guyuron, Bahman M.D.

Plastic and Reconstructive Surgery: March 2013 - Volume 131 - Issue 3 - p 351e–356e
doi: 10.1097/PRS.0b013e31827c6f71
Reconstructive: Head and Neck: Original Articles

Background: This study was designed to compare the success of occipital migraine headache surgery with and without occipital artery ligation.

Methods: The medical charts of 170 occipital migraine headache surgery recipients who fulfilled the study criteria were reviewed. Patients were divided into either the occipital artery resection group (one or both occipital arteries or its branches resected) or the control group (occipital arteries untouched). Preoperative and 12-month or more postoperative migraine frequency, duration, and intensity were analyzed.

Results: Fifty-five of the 170 patients met the inclusion criteria for the resection group; the remaining 115 were included in the control group. Of the 55 occipital artery resection patients, 44 (80.0 percent) had successful outcomes (≥50 percent reduction in occipital migraine headaches), with 21 (38.2 percent) experiencing elimination of migraines. Of the 115 control patients, 105 (91.3 percent) experienced success, with 74 (64.3 percent) experiencing elimination of occipital migraine headache. The control group had significantly higher success (p = 0.047) and elimination rates (p = 0.002) compared with the resection group. The control group had significantly greater mean reduction in migraine duration compared with the resection group (p = 0.008).

Conclusions: Occipital artery resection significantly lowered the success of occipital migraine headache surgery. Greater occipital nerve decompression alone, without ligation of the occipital artery, significantly improved or eliminated occipital migraine headache in most patients. This suggests that routine removal of the occipital artery or its branches may not be necessary.


Cleveland, Ohio

From the Department of Plastic Surgery, University Hospitals Case Medical Center, and Case Western Reserve University School of Medicine.

Received for publication August 14, 2012; accepted September 20, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Bahman Guyuron, M.D.; 29017 Cedar Road, Cleveland, Ohio 44124,

©2013American Society of Plastic Surgeons