{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T10:57:31Z","timestamp":1793271451339,"version":"4.5.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary:<\/jats:title>\n                    <jats:p>\n                      In an ongoing effort to understand the pathogenesis of occipital neuralgia\/headache\/migraine, it is critical to describe the anatomical\/tissue changes encountered during surgery. Greater occipital nerve anatomical studies mainly focus on the greater occipital nerve course through muscle\/fascial planes and interaction with the occipital vessels. However, structural soft-tissue changes have not been described in detail. Anecdotally, trapezius fascia is thickened at the greater occipital nerve trigger site. This study further investigates this observation. Patients undergoing greater occipital nerve decompression surgery were enrolled prospectively in this observational study (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 92). Tissue changes were recorded intraoperatively. The resulting data were examined. Trapezius fascia was more than 3 mm thick and appeared fibrotic in 86 patients (94 percent), whereas semispinalis muscle appeared normal in all subjects. The greater occipital nerve was macroscopically abnormal, defined as edematous, flattened, and discolored in 29 cases (32 percent). The occipital artery interacted significantly with the greater occipital nerve in 88 percent of cases. The authors conclude that the tissue structure is abnormal in patients undergoing greater occipital nerve decompression surgery. This is the first study that describes the prevalence of thickened and fibrotic appearing trapezius fascia at the occipital trigger site, a phenomenon encountered in the vast majority of patients (94 percent). This structural anomaly has a resemblance to thickened fascial tissues seen in other nerve compression syndromes, and could be related to microtrauma\/overuse or actual trauma in the head and neck region.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/prs.0000000000007484","type":"journal-article","created":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T13:53:08Z","timestamp":1608731588000},"page":"176-180","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":46,"title":["Muscle Fascia Changes in Patients with Occipital Neuralgia, Headache, or Migraine"],"prefix":"10.1097","volume":"147","author":[{"given":"Lisa","family":"Gfrerer","sequence":"first","affiliation":[{"name":"From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek A.","family":"Hansdorfer","sequence":"additional","affiliation":[{"name":"From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo O.","family":"Amador","sequence":"additional","affiliation":[{"name":"From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Chartier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassandra P.","family":"Nealon","sequence":"additional","affiliation":[{"name":"From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William G.","family":"Austen","sequence":"additional","affiliation":[{"name":"From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,12,24]]},"reference":[{"key":"R1-20250501","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1097\/01.PRS.0000161679.26890.EE","article-title":"The lesser and third occipital nerves and migraine headaches.","volume":"115","author":"Dash","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"R2-20250501","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1097\/PRS.0b013e318199f080","article-title":"Anatomical variations of the occipital nerves: Implications for the treatment of chronic headaches.","volume":"123","author":"Ducic","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"R3-20250501","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.bjps.2013.06.016","article-title":"Intraoperative anatomical variations during greater occipital nerve decompression.","volume":"66","author":"Junewicz","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"R4-20250501","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1097\/PRS.0b013e3182a80721","article-title":"An anatomical study of the lesser occipital nerve and its potential compression points: Implications for surgical treatment of migraine headaches.","volume":"132","author":"Lee","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"R5-20250501","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/01.PRS.0000101502.22727.5D","article-title":"The anatomy of the greater occipital nerve: Implications for the etiology of migraine headaches.","volume":"113","author":"Mosser","year":"2004","journal-title":"Plast Reconstr Surg"},{"key":"R6-20250501","doi-asserted-by":"crossref","first-page":"e639","DOI":"10.1097\/GOX.0000000000000654","article-title":"Anatomic and compression topography of the lesser occipital nerve.","volume":"4","author":"Peled","year":"2016","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"R7-20250501","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1097\/PRS.0b013e3181ef7f0c","article-title":"The anatomy of the greater occipital nerve: Part II. Compression point topography.","volume":"126","author":"Janis","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"R8-20250501","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1097\/PRS.0b013e3181ef8c6b","article-title":"Neurovascular compression of the greater occipital nerve: Implications for migraine headaches.","volume":"126","author":"Janis","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"R9-20250501","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1002\/ca.23388","article-title":"Fascial entrapment neuropathy.","volume":"32","author":"Stecco","year":"2019","journal-title":"Clin Anat"},{"key":"R10-20250501","first-page":"167","article-title":"Ultrasonography for the assessment of the upper trapezius properties in healthy females: A reliability study.","volume":"6","author":"Adigozali","year":"2016","journal-title":"Muscles Ligaments Tendons J"},{"key":"R11-20250501","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jcm.2017.06.003","article-title":"Reliability of the upper trapezius muscle and fascia thickness and strain ratio measures by ultrasonography and sonoelastography in participants with myofascial pain syndrome.","volume":"16","author":"Salavati","year":"2017","journal-title":"J Chiropr Med"},{"key":"R12-20250501","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/PRS.0000000000003955","article-title":"Ability to cope with pain puts migraine surgery patients in perspective.","volume":"141","author":"Gfrerer","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"R13-20250501","doi-asserted-by":"crossref","first-page":"129","DOI":"10.5414\/NPP28129","article-title":"Pathological findings in subsynovial connective tissue in idiopathic carpal tunnel syndrome.","volume":"28","author":"Donato","year":"2009","journal-title":"Clin Neuropathol"},{"key":"R14-20250501","doi-asserted-by":"crossref","first-page":"31","DOI":"10.7863\/jum.2012.31.1.31","article-title":"Sonographic measurements of subsynovial connective tissue thickness in patients with carpal tunnel syndrome.","volume":"31","author":"van Doesburg","year":"2012","journal-title":"J Ultrasound Med"},{"key":"R15-20250501","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s11552-012-9469-2","article-title":"The effect of time after shear injury on the subsynovial connective tissue and median nerve within the rabbit carpal tunnel.","volume":"8","author":"Vanhees","year":"2013","journal-title":"Hand (N Y)"},{"key":"R16-20250501","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1126\/science.aam7928","article-title":"Inflammation and metabolism in tissue repair and regeneration.","volume":"356","author":"Eming","year":"2017","journal-title":"Science"},{"key":"R17-20250501","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/PRS.0000000000007019","article-title":"The efficacy of surgical treatment for headaches in patients with prior head or neck trauma.","volume":"146","author":"Ortiz","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"R18-20250501","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/PRS.0b013e3182173d64","article-title":"Validation of the peripheral trigger point theory of migraine headaches: Single-surgeon experience using botulinum toxin and surgical decompression.","volume":"128","author":"Janis","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"R19-20250501","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1097\/PRS.0000000000004795","article-title":"Surgical treatment of migraine headache: Back to the future.","volume":"142","author":"Gfrerer","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"R20-20250501","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1097\/PRS.0b013e3182174229","article-title":"Occipital artery vasculitis not identified as a mechanism of occipital neuralgia-related chronic migraine headaches.","volume":"128","author":"Ducic","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"R21-20250501","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s00238-016-1249-8","article-title":"Tips for the surgical treatment of occipital nerve-triggered headaches.","volume":"40","author":"Raposio","year":"2017","journal-title":"Eur J Plast Surg"}],"container-title":["Plastic &amp; Reconstructive Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PRS.0000000000007484","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T20:20:36Z","timestamp":1746130836000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PRS.0000000000007484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,24]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1097\/prs.0000000000007484","relation":{},"ISSN":["0032-1052"],"issn-type":[{"value":"0032-1052","type":"print"}],"subject":[],"published":{"date-parts":[[2020,12,24]]}}}