Surgical Decompression for Refractory Chronic Migraine: Clinical Outcomes and a Novel Endoscopic Technique (2020–2024)

Abstract

This retrospective study summarizes clinical outcomes and technical developments in peripheral nerve decompression surgery for refractory chronic migraine (CM) at a single institution from 2020 to 2024. We reviewed the records of 231 patients with refractory CM who underwent surgical decompression of identified peripheral trigger zones (frontal, temporal, occipital, or nasal). The primary objectives were to: 1) summarize overall clinical efficacy using standardized metrics (MIDAS, HIT-6, VAS); 2) analyze the comparative effectiveness across the four major anatomical zones; and 3) describe preliminary outcomes for a novel, patented endoscopic technique for greater occipital nerve (GON) decompression. At 12-month follow-up, 93.1% of patients achieved significant clinical improvement, with 86.1% experiencing complete or near-complete migraine resolution. Efficacy was consistent across all trigger sites. Complication rates were low (4.3%). The novel endoscopic GON technique, employed in a subset of patients, demonstrated enhanced visualization and a favorable safety profile with no postoperative hematomas and minimal recurrence. This study confirms that peripheral nerve decompression is a highly effective intervention for refractory CM and introduces a promising technical advancement that may improve precision and reduce morbidity, warranting further prospective validation.