Neurolysis of the greater occipital nerve in cervicogenic headache. A follow up study.

Entrapment of the greater occipital nerve (GON) in its peripheral course has been thought to be of possible pathogenic significance in cervicogenic headache. We have performed a "liberation" operation ("neurolysis") of the nerve in the nuchal musculature, with special attention to the trapezius insertion, and the follow-up results in 50 patients are presented. The immediate effect of the operation was quite good, but the pain gradually recurred in the majority (46/50) of the patients. Eventually, all operated patients will probably have recurrence of pain episodes. Nevertheless, most patients claim that the overall disability is less after the operation, and 40% actually want to undergo a new, identical procedure. The justification for doing a second "liberation" operation is clearly less than for a first operation. In our opinion, this operation should not be performed in patients with cervicogenic headache in general. The present study shows that other therapeutic approaches should be searched for in cervicogenic headache.