Lesser occipital nerve decompression for medically refractory occipital headache: A retrospective case series

Chronic intractable headaches significantly impair quality of life. Entrapment of the greater (GON) and lesser occipital nerves (LON) has been proposed as a potential cause of occipital headaches. While GON decompression has been widely studied, reports regarding the surgical technique and outcomes of LON decompression remain limited. This study aims to evaluate the clinical effectiveness of LON decompression in patients with medically refractory occipital headaches.

A retrospective analysis was conducted on patients who underwent LOND between April 2021 and December 2024. Diagnostic C2 and/or C3 cervical blocks were used to support the clinical suspicion of occipital nerve-related headache with LON-predominant distribution. Pain was assessed using the Visual Analog Scale (VAS), Douleur Neuropathique 4 (DN4), and Neuropathic Pain Symptom Inventory (NPSI). Quality of life was measured using the SF-36. Operative details and relevant LON anatomical considerations are described.

Nineteen patients were included in this study. Postoperatively, VAS scores decreased significantly (P < 0.001), with corresponding improvements in DN4 (P = 0.021) and NPSI (P < 0.001) scores. SF-36 physical (P = 0.002) and mental component (P < 0.001) scores also improved notably. A longer duration of response to diagnostic blocks was associated with greater postoperative improvement in DN4 scores. No major complications were observed.

LON decompression may represent a safe and effective surgical option for selected patients with chronic occipital headaches refractory to conservative treatment, providing meaningful pain relief and improvements in quality of life. Larger, prospective studies are warranted to refine surgical indications and confirm long-term efficacy.