• Lauren Chmielewski, Mengyuan T Liu, and Bahman Guyuron.
• Cleveland, Ohio From the Department of Plastic Surgery, University Hospitals Case Medical Center, and Case Western Reserve University School of Medicine.
• Plast. Reconstr. Surg. 2013 Mar 1; 131 (3): 351e-356e.

BackgroundThis study was designed to compare the success of occipital migraine headache surgery with and without occipital artery ligation.MethodsThe medical charts of 170 occipital migraine headache surgery recipients who fulfilled the study criteria were reviewed. Patients were divided into either the occipital artery resection group (one or both occipital arteries or its branches resected) or the control group (occipital arteries untouched). Preoperative and 12-month or more postoperative migraine frequency, duration, and intensity were analyzed.ResultsFifty-five of the 170 patients met the inclusion criteria for the resection group; the remaining 115 were included in the control group. Of the 55 occipital artery resection patients, 44 (80.0 percent) had successful outcomes (≥ 50 percent reduction in occipital migraine headaches), with 21 (38.2 percent) experiencing elimination of migraines. Of the 115 control patients, 105 (91.3 percent) experienced success, with 74 (64.3 percent) experiencing elimination of occipital migraine headache. The control group had significantly higher success (p = 0.047) and elimination rates (p = 0.002) compared with the resection group. The control group had significantly greater mean reduction in migraine duration compared with the resection group (p = 0.008).ConclusionsOccipital artery resection significantly lowered the success of occipital migraine headache surgery. Greater occipital nerve decompression alone, without ligation of the occipital artery, significantly improved or eliminated occipital migraine headache in most patients. This suggests that routine removal of the occipital artery or its branches may not be necessary.

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