{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:23:24Z","timestamp":1787844204805,"version":"build-2784847793"},"reference-count":64,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Occipital neuralgia (ON) is a primary headache disorder characterized by sharp, shooting, or electric shock-like pain in the distribution of the greater, lesser, or third occipital nerves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To review the existing literature on the management of ON and to describe our technique of an endoscopic-assisted approach to decompress the GON proximally in areas of fibrous and muscular compression, as well as distally by thorough decompression of the occipital artery from the nerve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Relevant literature on the medical and surgical management of ON was reviewed. Literature on the anatomical relationships of occipital nerves and their clinical relevance were also reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>While initial treatment of ON is conservative, peripheral nerve blocks and many surgical management approaches are available for patients with pain refractory to the medical treatment. These include greater occipital nerve blocks, occipital nerve stimulation, Botulinum toxin injections locally, pulsed radiofrequency ablation, cryoneuroablation, C-2 ganglionectomy, and endoscopic-assisted ON decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Patients of ON refractory to medical management can be benefitted by surgical approaches and occipital nerve blocks. Endoscopic-assisted ON decompression provides one such approach for the patients with vascular, fibrous or muscular compressions of occipital nerves resulting in intractable ON.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0028-3886.315980","type":"journal-article","created":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T04:19:32Z","timestamp":1621138772000},"page":"S219-S227","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Occipital Neuralgia"],"prefix":"10.4103","volume":"69","author":[{"given":"Christine E","family":"Wamsley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bardia","family":"Amirlak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-28-20240907","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s11916-014-0411-x","article-title":"Occipital neuralgia","volume":"18","author":"Dougherty","year":"2014","journal-title":"Curr Pain Headache Rep"},{"key":"R2-28-20240907","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.pain.2009.08.023","article-title":"Incidence of facial pain in the general population","volume":"147","author":"Koopman","year":"2009","journal-title":"Pain"},{"key":"R3-28-20240907","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":"R4-28-20240907","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.PRS.0000145631.20901.84","article-title":"Comprehensive surgical treatment of migraine headaches","volume":"115","author":"Guyuron","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"R5-28-20240907","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/PRS.0000000000001322","article-title":"A prospective randomized outcomes comparison of two temple migraine trigger site deactivation techniques","volume":"136","author":"Guyuron","year":"2015","journal-title":"Plast Reconstr Surg"},{"key":"R6-28-20240907","doi-asserted-by":"crossref","first-page":"351e","DOI":"10.1097\/PRS.0b013e31827c6f71","article-title":"The role of occipital artery resection in the surgical treatment of occipital migraine headaches","volume":"131","author":"Chmielewski","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"R7-28-20240907","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1097\/PRS.0b013e3181a0720e","article-title":"Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia","volume":"123","author":"Ducic","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"R8-28-20240907","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1177\/0333102418801585","article-title":"Tracking patients with chronic occipital headache after occipital nerve decompression surgery: A case series","volume":"39","author":"Blake","year":"2019","journal-title":"Cephalalgia"},{"key":"R9-28-20240907","doi-asserted-by":"crossref","first-page":"e678","DOI":"10.1097\/GOX.0000000000000663","article-title":"Decompression-avulsion of the auriculotemporal nerve for treatment of migraines and chronic headaches","volume":"4","author":"Sanniec","year":"2016","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"R10-28-20240907","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s13760-012-0126-x","article-title":"Occipital neuralgia as an unusual manifestation of herpes zoster infection of the lesser occipital nerve: A case report","volume":"113","author":"Ipekdal","year":"2013","journal-title":"Acta Neurol Belg"},{"key":"R11-28-20240907","doi-asserted-by":"crossref","first-page":"447","DOI":"10.36076\/ppj\/2019.22.447","article-title":"Neurostimulation for the treatment of chronic head and facial pain: A literature review","volume":"22","author":"Antony","year":"2019","journal-title":"Pain Physician"},{"key":"R12-28-20240907","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/j.1468-1331.2004.00875.x","article-title":"Greater occipital neuralgia and arthrosis of C1-2 lateral joint","volume":"11","author":"Tancredi","year":"2004","journal-title":"Eur J Neurol"},{"key":"R13-28-20240907","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/ner.13223","article-title":"Efficacy of occipital nerve stimulation to treat refractory occipital headaches: A single-institution study of 60 patients","volume":"23","author":"Raoul","year":"2020","journal-title":"Neuromodulation"},{"key":"R14-28-20240907","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/j.1533-2500.2009.00355.x","article-title":"Occipital neuralgia","volume":"10","author":"Vanelderen","year":"2010","journal-title":"Pain Pract"},{"key":"R15-28-20240907","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1046\/j.1525-1403.1999.00217.x","article-title":"Peripheral neurostimulation for control of intractable occipital neuralgia","volume":"2","author":"Weiner","year":"1999","journal-title":"Neuromodulation"},{"key":"R16-28-20240907","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.clineuro.2010.11.021","article-title":"The importance of the greater occipital nerve in the occipital and the suboccipital region for nerve blockade and surgical approaches--An anatomic study on cadavers","volume":"113","author":"G\u00fcven\u00e7er","year":"2011","journal-title":"Clin Neurol Neurosurg"},{"key":"R18-28-20240907","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1177\/0333102410381142","article-title":"Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study","volume":"31","author":"Saper","year":"2011","journal-title":"Cephalalgia"},{"key":"R19-28-20240907","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1097\/PRS.0000000000007049","article-title":"In-depth look at the anatomical relationship of the lesser occipital nerve, great auricular nerve, and spinal accessory nerve and their implication in safety of operations in the posterior triangle of the neck","volume":"146","author":"Amirlak","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"R21-28-20240907","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1111\/head.12579","article-title":"Occipital and trigeminal nerve blocks for migraine","volume":"55","author":"Blumenfeld","year":"2015","journal-title":"Headache"},{"key":"R22-28-20240907","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0304-3959(97)00074-2","article-title":"Stimulation of the greater occipital nerve increases metabolic activity in the trigeminal nucleus caudalis and cervical dorsal horn of the cat","volume":"73","author":"Goadsby","year":"1997","journal-title":"Pain"},{"key":"R23-28-20240907","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1111\/head.12053","article-title":"Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--A narrative review","volume":"53","author":"Blumenfeld","year":"2013","journal-title":"Headache"},{"key":"R24-28-20240907","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":"R25-28-20240907","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.bjps.2013.05.023","article-title":"The role of the third occipital nerve in surgical treatment of occipital migraine headaches","volume":"66","author":"Lee","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"R26-28-20240907","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1111\/j.1526-4610.2010.01675.x","article-title":"Peripheral nerve blocks and trigger point injections in headache management-A systematic review and suggestions for future research","volume":"50","author":"Ashkenazi","year":"2010","journal-title":"Headache"},{"key":"R27-28-20240907","first-page":"158","article-title":"Occipital neuralgias: Clinical recognition of a complicated headache. A case series and literature review","volume":"11","author":"Kuhn","year":"1997","journal-title":"J Orofac Pain"},{"key":"R28-28-20240907","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.3390\/toxins7083127","article-title":"Botulinum toxin for neuropathic pain: A review of the literature","volume":"7","author":"Oh","year":"2015","journal-title":"Toxins (Basel"},{"key":"R29-28-20240907","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1177\/0333102410364676","article-title":"OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial","volume":"30","author":"Aurora","year":"2010","journal-title":"Cephalalgia"},{"key":"R30-28-20240907","doi-asserted-by":"crossref","first-page":"e228562","DOI":"10.1136\/bcr-2018-228562","article-title":"OnabotulinumtoxinA injections: Treatment of reversible cerebral vasoconstriction syndrome chronic daily headaches","volume":"12","author":"Senno","year":"2019","journal-title":"BMJ Case Rep"},{"key":"R31-28-20240907","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1046\/j.1526-4610.43.7s.5.x","article-title":"Botulinum neurotoxin for the treatment of migraine and other primary headache disorders: From bench to bedside","volume":"43","author":"Dodick","year":"2003","journal-title":"Headache"},{"key":"R32-28-20240907","doi-asserted-by":"crossref","first-page":"129","DOI":"10.2217\/pmt.13.75","article-title":"Botulinum toxin for neuropathic pain and spasticity: An overview","volume":"4","author":"Brown","year":"2014","journal-title":"Pain Manag"},{"key":"R33-28-20240907","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/j.1533-2500.2007.00150.x","article-title":"Botulinum toxin occipital nerve block for the treatment of severe occipital neuralgia: A case series","volume":"7","author":"Kapural","year":"2007","journal-title":"Pain Pract"},{"key":"R34-28-20240907","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1111\/j.1526-4610.2008.01089.x","article-title":"Botulinum toxin type-A (BOTOX) in the treatment of occipital neuralgia: A pilot study","volume":"48","author":"Taylor","year":"2008","journal-title":"Headache"},{"key":"R35-28-20240907","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1055\/s-0036-1571953","article-title":"Botulinum Toxin Treatment of neuropathic pain","volume":"36","author":"Mittal","year":"2016","journal-title":"Semin Neurol"},{"key":"R36-28-20240907","doi-asserted-by":"crossref","first-page":"e1194","DOI":"10.1097\/GOX.0000000000001194","article-title":"Anatomical regional targeted (ART) BOTOX injection technique: A novel paradigm for migraines and chronic headaches","volume":"4","author":"Amirlak","year":"2016","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"R37-28-20240907","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1111\/j.1526-4637.2012.01348.x","article-title":"Occipital nerve pulsed radiofrequency treatment: A multi-center study evaluating predictors of outcome","volume":"13","author":"Huang","year":"2012","journal-title":"Pain Med"},{"key":"R38-28-20240907","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1526-4637.2006.00217.x","article-title":"A case of pulsed radiofrequency lesioning for occipital neuralgia","volume":"7","author":"Navani","year":"2006","journal-title":"Pain Med"},{"key":"R40-28-20240907","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00701-010-0881-5","article-title":"Pulsed radiofrequency treatment in interventional pain management: Mechanisms and potential indications-A review","volume":"153","author":"Chua","year":"2011","journal-title":"Acta Neurochir (Wien"},{"key":"R41-28-20240907","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/AAP.0b013e3181d24713","article-title":"Pulsed radiofrequency for the treatment of occipital neuralgia: A prospective study with 6 months of follow-up","volume":"35","author":"Vanelderen","year":"2010","journal-title":"Reg Anesth Pain Med"},{"key":"R42-28-20240907","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1097\/j.pain.0000000000000373","article-title":"Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness","volume":"156","author":"Cohen","year":"2015","journal-title":"Pain"},{"key":"R43-28-20240907","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1111\/papr.12779","article-title":"New technique for cryoneuroablation of the proximal greater occipital nerve","volume":"19","author":"Stogicza","year":"2019","journal-title":"Pain Pract"},{"key":"R44-28-20240907","doi-asserted-by":"crossref","first-page":"E363","DOI":"10.36076\/ppj.2015\/18\/E363","article-title":"Cryoablation for the treatment of occipital neuralgia","volume":"18","author":"Kim","year":"2015","journal-title":"Pain Physician"},{"key":"R45-28-20240907","doi-asserted-by":"crossref","first-page":"345","DOI":"10.36076\/ppj.2003\/6\/345","article-title":"Cryoanalgesia in interventional pain management","volume":"6","author":"Trescot","year":"2003","journal-title":"Pain Physician"},{"key":"R46-28-20240907","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1002\/ana.410100512","article-title":"Biophysical and pathological effects of cryogenic nerve lesion","volume":"10","author":"Myers","year":"1981","journal-title":"Ann Neurol"},{"key":"R47-28-20240907","first-page":"337","article-title":"Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia","volume":"65","author":"Loukas","year":"2006","journal-title":"Folia Morphol (Warsz"},{"key":"R48-28-20240907","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1093\/bja\/aeq052","article-title":"Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: A comparison of two selective techniques confirmed by anatomical dissection","volume":"104","author":"Greher","year":"2010","journal-title":"Br J Anaesth"},{"key":"R49-28-20240907","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.neurad.2017.11.002","article-title":"Greater occipital nerve cryoneurolysis in the management of intractable occipital neuralgia","volume":"45","author":"Kastler","year":"2018","journal-title":"J Neuroradiol"},{"key":"R50-28-20240907","first-page":"223","article-title":"Pain suppression by peripheral nerve stimulation. Chronic effects of implanted devices","volume":"40","author":"Picaza","year":"1977","journal-title":"Appl Neurophysiol"},{"key":"R52-28-20240907","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1526-4610.2007.01022.x","article-title":"Occipital nerve stimulation for headache: Mechanisms and efficacy","volume":"48","author":"Goadsby","year":"2008","journal-title":"Headache"},{"key":"R53-28-20240907","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/ner.12215","article-title":"The appropriate use of neurostimulation: Stimulation of the intracranial and extracranial space and head for chronic pain. Neuromodulation Appropriateness Consensus Committee","volume":"17","author":"Deer","year":"2014","journal-title":"Neuromodulation"},{"key":"R54-28-20240907","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1526-4610.2007.01023.x","article-title":"Occipital nerve stimulation: Technical and surgical aspects of implantation","volume":"48","author":"Trentman","year":"2008","journal-title":"Headache"},{"key":"R55-28-20240907","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1525-1403.2006.00041.x","article-title":"Occipital nerve stimulation for the treatment of occipital neuralgia-eight case studies","volume":"9","author":"Johnstone","year":"2006","journal-title":"Neuromodulation"},{"key":"R56-28-20240907","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/j.1468-2982.2007.01272.x","article-title":"Occipital nerve stimulation for chronic headache--long-term safety and efficacy","volume":"27","author":"Schwedt","year":"2007","journal-title":"Cephalalgia"},{"key":"R57-28-20240907","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1227\/01.NEU.0000192163.55428.62","article-title":"Peripheral neurostimulation for treatment of intractable occipital neuralgia","volume":"58","author":"Slavin","year":"2006","journal-title":"Neurosurgery"},{"key":"R58-28-20240907","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1093\/brain\/awh006","article-title":"Left and right hand recognition in upper limb amputees","volume":"127","author":"Nico","year":"2004","journal-title":"Brain"},{"key":"R59-28-20240907","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1093\/pm\/pnaa083","article-title":"Peripheral nerve stimulation for occipital neuralgia","volume":"21","author":"Salmasi","year":"2020","journal-title":"Pain Med"},{"key":"R60-28-20240907","first-page":"167","article-title":"The anatomy of occipital neuralgia","volume":"17","author":"Bogduk","year":"1980","journal-title":"Clin Exp Neurol"},{"key":"R61-28-20240907","doi-asserted-by":"crossref","first-page":"359","DOI":"10.3171\/jns.1998.89.3.0359","article-title":"Microsurgical C-2 ganglionectomy for chronic intractable occipital pain","volume":"89","author":"Lozano","year":"1998","journal-title":"J Neurosurg"},{"key":"R62-28-20240907","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1017\/S0317167100036076","article-title":"\u201cWhiplash\u201d-injury of the 2nd cervical ganglion and nerve","volume":"13","author":"Keith","year":"1986","journal-title":"Can J Neurol Sci"},{"key":"R63-28-20240907","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1159\/000113872","article-title":"Pain relief after cervical ganglionectomy (C2 and C3) for the treatment of medically intractable occipital neuralgia","volume":"86","author":"Acar","year":"2008","journal-title":"Stereotact Funct Neurosurg"},{"key":"R64-28-20240907","doi-asserted-by":"crossref","first-page":"e2291","DOI":"10.1097\/GOX.0000000000002291","article-title":"Migraine surgery","volume":"7","author":"Gfrerer","year":"2019","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"R65-28-20240907","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S1474-4422(18)30085-1","article-title":"International classification of headache disorders","volume":"17","author":"Olesen","year":"2018","journal-title":"Lancet Neurol"},{"key":"R67-28-20240907","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":"R70-28-20240907","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s10072-015-2195-0","article-title":"Rationale for use of onabotulinum toxin A (BOTOX) in chronic migraine","volume":"36","author":"Barbanti","year":"2015","journal-title":"Neurol Sci"},{"key":"R71-28-20240907","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/SAP.0b013e3182898736","article-title":"Greater occipital nerve excision for occipital neuralgia refractory to nerve decompression","volume":"72","author":"Ducic","year":"2014","journal-title":"Ann Plast Surg"}],"container-title":["Neurology India"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/0028-3886.315980","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:13:59Z","timestamp":1787843639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/0028-3886.315980"}},"subtitle":["Advances in the Operative Management"],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":64,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/0028-3886.315980","relation":{},"ISSN":["0028-3886"],"issn-type":[{"value":"0028-3886","type":"print"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}