Secondary Trigger Point Deactivation Surgery for Nerve Compression Headaches: A Scoping Review

Area of Science:

• Neurosurgery
• Pain Management
• Headache Disorders

Background:

• Primary trigger point deactivation surgery effectively treats nerve compression headaches in 79-90% of cases.
• Failure of initial surgery necessitates understanding contributing factors and reevaluating trigger points.
• This review explores reasons for primary surgery failure and secondary surgical options.

Purpose of the Study:

• To discuss factors contributing to trigger point deactivation surgery failure.
• To emphasize the importance of reevaluating trigger points after initial surgery.
• To outline options for secondary surgical interventions.

Main Methods:

• A comprehensive literature search was conducted using keywords related to chronic headache and nerve deactivation surgery.
• Databases were searched up to February 2023.
• Eleven articles comprising data from 1071 patients were included in the analysis.

Main Results:

• The failure rate for primary trigger point deactivation surgery is approximately 12%, often due to incomplete deactivation.
• New trigger points emerge post-primary surgery in 17.8% of patients.
• Management strategies for failure include reevaluation, addressing scarring (e.g., corticosteroid injections, dermal matrix), neuroma treatment (e.g., TMR, nerve grafting), and neurectomy.

Conclusions:

• Secondary trigger point deactivation surgery is indicated for incomplete deactivation, internal scarring, neuroma formation, or newly identified trigger points.
• Thorough reevaluation and preoperative testing are crucial for identifying candidates for secondary surgery.
• Various surgical techniques exist to manage complications and improve outcomes after failed primary surgery.