Headache Plagued Him for 40 Years; Minimally Invasive Nerve Decompression Surgery by Neurosurgery Team Brings Relief
A 56-year-old man from Xinjiang had suffered from headaches for more than four decades, with near-daily attacks over the past three years. Medications only brought partial relief. He traveled thousands of miles to the Department of Neurosurgery, Taikang Xianlin Drum Tower Hospital, Nanjing University School of Medicine, to see Associate Chief Physician Xu Aigang. After two diagnostic nerve blocks for localization and a microscopic minimally invasive nerve decompression surgery, his long-standing headache achieved satisfactory relief.
40 Years of Headache, Multiple Treatments Tried
In September, Mr. Wang, aged 56, traveled all the way from Xinjiang to the hospital. For 40 years, he endured headaches that became almost daily in the last three years.
His pain centered on both temples and the occipital region, presenting as persistent distending pain and throbbing pain. It worsened gradually after waking up, peaking from afternoon to evening. Severe episodes came with nausea, vomiting, blurred vision and elevated blood pressure, greatly limiting his daily activities.
Over the decades, he tried oral medications, traditional Chinese acupuncture, herbal medicine and plasma radiofrequency ablation for headache nerves, with little desired improvement. Even taking triptans and compound painkillers twice a day only eased the pain moderately.
Seeking Treatment Across Miles: Two Nerve Blocks Pinpoint the Source of Pain
Learning that Associate Chief Physician Xu Aigang specialized in minimally invasive nerve decompression for refractory headaches, Mr. Wang flew from Xinjiang for consultation. After reviewing his medical history and conducting a thorough physical examination, Dr. Xu diagnosed him with chronic intractable migraine and admitted him the same day.
During hospitalization, Dr. Xu’s team performed two diagnostic nerve blocks. Simply put, a nerve block is like temporarily “switching off” the suspected pain nerve. Local anesthetic is injected along the course of the greater occipital nerve and auriculotemporal nerve, where the headache is thought to originate.
If the original headache fades or disappears markedly within hours after the block, that nerve is very likely the main pathway for pain signals, identifying precise targets for decompression surgery.
Results from both blocks consistently pointed to peripheral nerve branches corresponding to bilateral Fengchi acupoint areas and the right temple, confirming the origin of his 40-year headache.
Minimally Invasive Surgery: Freeing the Nerve Under Microscope
With the pain source confirmed, Dr. Xu’s team carried out minimally invasive nerve decompression. Guided by the preoperatively mapped trigger points, a small incision was made. Tissues were dissected layer by layer to reach the nerve pathway, where compression between the nerve and surrounding blood vessels, fascia and muscles was explored.
Intraoperatively, the nerve was found compressed by tortuous, dilated blood vessels and tightly adhered to fascia. Long-term compression had left the nerve pale and deformed.
Under the microscope, Dr. Xu carefully separated the compressing vessels and cut adhesive bands to release all compression sites, freeing the nerve. Soft barrier material was placed between the nerve and vessels to block pulsatile vascular impact and lower the risk of recurrent compression.
Expert Warning: Surgery Is Not Suitable for All Headaches
Microscopic nerve decompression is mainly indicated for patients who have undergone standardized medication and preventive therapy, received specialized headache evaluation, and have clear trigger points with examination or imaging evidence showing compression of peripheral nerves (greater occipital, auriculotemporal, supraorbital nerves, etc.) by blood vessels, fascia or muscles.
The neurosurgery team reminds the public: Headache is a warning sign. Occasional headaches with clear triggers often improve with lifestyle adjustments. However, headaches that flare up for more than ten days a month for months on end and fail to respond to medication require serious medical attention. Chronic headache patients should first receive standardized assessment at a specialized headache clinic for a confirmed diagnosis and personalized treatment plan. Do not stop medicine on your own or rush into surgery blindly.
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