Nerve Decompression Surgery for Chronic Headache

Some patients with persistent occipital nerve–related pain reach a point where nerve decompression surgery is the logical next step. This page explains what that means, how headacheMD^® fits in, and how financial help may be available—without overstating what any single treatment can promise.

What is nerve decompression surgery?

Nerve decompression surgery is an operative procedure to release compressed or entrapped nerves—often the greater and lesser occipital nerves at the back of the head—so they are no longer chronically irritated by surrounding muscle, fascia, or vessels. It is not a “migraine cure” for everyone; it is a mechanical solution for selected patients whose pain pattern and exam findings point to peripheral nerve compression as a major driver.

When surgery is considered

Surgery is not a first step. Candidates typically have persistent, disabling symptoms despite appropriate medical therapy; a history and exam consistent with occipital nerve involvement; and often a meaningful response to diagnostic nerve blocks—meaning numbing the nerve temporarily reduces pain in a predictable way. Those clues help the neurologist and surgeon agree that surgery addresses the right problem.

The headacheMD® pathway (diagnosis first)

headacheMD^® Houston PLLC provides neurology and headache medicine evaluation; we do not perform surgery in the clinic. Dr. Blake and our physician assistants work within her protocols to clarify the diagnosis, optimize non-surgical care, and refer to a surgeon in the headacheMD^® network when surgical evaluation is appropriate.

Surgeons in the network

Houston: Dr. Neil McMullin, board-certified plastic surgeon, sees referrals coordinated through our practice and operates in settings including Lone Star Surgery Center.

Austin / Central Texas: Dr. Scott Reis, board-certified plastic surgeon, evaluates surgical candidates in the Austin area and hosts the monthly headacheMD^® Austin clinic for neurology visits.

Surgeons are independent practitioners; headacheMD^® coordinates the referral pathway and shared standards of care, not the technical performance of surgery itself.

What to expect (general information)

Details vary by patient and surgeon, but many procedures are outpatient, with recovery measured in weeks. Your surgeon discusses incision placement, realistic outcomes, and risks. Neurology follow-up continues to address headache care in the broader sense after surgery.

Shared decision-making

Surgery is a personal choice made with good information. Some patients improve substantially; others have partial relief or find that headache was multifactorial and still needs medical management afterward. We encourage you to ask questions about evidence, alternatives, and recovery time. Our role in neurology is to help you decide whether surgery addresses the problem we have identified—or whether more medical optimization should come first.

headacheMD® For All Foundation

The headacheMD^® For All Foundation is a 501(c)(3) nonprofit that may help eligible patients with third-party surgical costs when financial need and clinical criteria are met. It does not replace insurance or surgeon fees directly in every case; it is a resource worth asking about during coordination. Learn more at www.hmdforall.org.

Related medical care pages

Read nerve compression headache, chronic migraine treatment, and educational content on headache.zone. Return to the main Houston clinic page for hours and directions.