PRIMARY HEADACHES
Headaches with no known cause.
- Migraine
- Tension headache
- Cluster headache
- Paroxysmal hemicrania
- SUNCT syndrome
- Essential throbbing headache
- Chronic Daily Headache
- Cough headache
- Benign physical exercise headache
- Benign coital headache
- Headache associated with cranial trauma
SECONDARY HEADACHES
Headaches with a known cause.
- Subarachnoid haemorrhage headache
- Giant cell arteritis
- Occipital or Arnold’s neuralgia
- Glossopharyngeal neuralgia (Wilfred-Harris syndrome)
- Atypical facial neuralgia
- Ophthalmoplegia dolorosa recurrens (Tolosa Hunt syndrome)
- Trigeminal neuralgia
- Neuropathic facial pain
Types of headaches where there is the possibility of surgical treatment
In the event that pharmacological treatment is not effective and the headache has become chronic, a surgical solution may be available in the following cases:
Migraine, Cluster headache, Paroxysmal hemicrania, Neuropathic facial pain (after tooth extraction, stroke, trigeminal neuralgia surgery, facial traumatism, etc.), atypical facial pain, occipital or Arnold’s neuralgia, glossopharyngeal neuralgia, cervicogenic headache, trigeminal neuralgia, continuous hemicranea, post-traumatic headache, C2 mediated headaches, transformed migraine, SUNCT, occipital pain following surgery, herpes zoster facial pain.
Surgical techniques for headache
These are the main surgical techniques for headache:
Major and minor occipital nerve stimulation
This is a simple treatment, performed under general anaesthetic, consisting of the placement of subcutaneous electrodes connected to a generator at a level of the major and minor occipital nerve. Its efficacy depends on the type of headache, but in general, the patient has a 60% possibility of improvement .
Radiofrequency of the pterygopalatine ganglion
This procedure is performed under local anaesthesia and minimum sedation and consists of ablating the pterygopalatine ganglion involved in the headache. The possibilities of improvement are 70%.
Stimulation of the cerebral cortex for neuropathic pain.
This procedure is only indicated in patients with intense neuropathic pain (facial or in other places of the body) that is refractory to medication. It consists on a surgery in two phases, as it requires a test phase (first surgery) to determine whether cerebral stimulation is effective for the patient. If so, the stimulus generator is implanted. It is effective in 60% of patients.
Mullan technique
It’s indicated for patients with disabling trigeminal neuralgia in spite of medication.
This is also known as balloon microcompression of Gasser’s Ganglion. It is a percutaneous technique, under general anaesthetic, offering a 70% probability of improvement of the disease. The complication rate is very low.
Jannetta technique
It’s indicated for patients with disabling trigeminal neuralgia in spite of medication. It is complex surgery under general anaesthetic. The possibility being pain-free with this technique is 90%
