When reviewing new research on the treatment of chronic migraine and occipital neuralgia, we see that many new studies focus on nerve blocks. If you suffer from chronic migraine or headaches with its determined source clearly pointing to occipital neuralgia, nerve block. is probably a treatment that you have been offered to or at least it has been discussed with you. Your doctor may have also discussed nerve stimulation and other treatments including the possibility of stem cell therapy. Before you read further on into this article, we do offer stem cell therapy to treat neurologic or nerve damage. Our focus is on the musculoskeletal component of the problem. The goal of our treatment is to strengthen the stability of the head and the back of the skull on the neck by treating and repairing damaged and injured cervical spine ligaments. Providing the neck with stability will reduce or possibly eliminate the headache generators, the suboccipital muscle spasm, at the base of the skull.
Back in 1997, at a time when I was first moving into regenerative medicine injections, doctors were still exploring 50 years of research trying to make a connection between a series of baffling and mysterious symptoms of headache and migraine and how they related to neck pain. One more peculiarity was that these headaches and migraines were also accompanied by more baffling symptoms.
In this 1997 study in the Journal of craniomandibular disorders, (1) doctors hoped to “assist clinicians in the diagnosis of the occipital neuralgia syndrome by describing its clinical characteristics.” So they went back to 1966 and examined all the research available up to 1993.
The key points of their findings were:
- Clinical features, other than headache, that were common in patients included:
- tinnitus in 33%;
- scalp paresthesia, 33%;
- nausea, 42%;
- dizziness, 50%; and
- visual disturbances, 67%.
This research concluded: “Occipital neuralgia is a benign extracranial cause of headache, and it may be confused with other more serious headache syndromes. Recognition depends on an understanding of the symptoms along with a careful history and physical examination. Local anesthetic injections (nerve block) produce significant relief of the headaches and can aid in the diagnosis of the syndrome.”
In our more than 20 years in offering regenerative medicine injections I have had many patients come in with these or a combination of these symptoms and headaches. We have been able to help many of these people by not treating their symptoms, but rather by treating their Occipital Neuralgia as a musculoskeletal disorder.
Why discuss a study from 1997? It is in point to illustrate that the challenges of diagnosis and understanding occipital neuralgia and headache are still significant challenges in the medical community. The Nerve block success reported in 1997 is still considered the best course of action according to many doctors. But, your own search of the internet looking for answers for your headaches is proof that you may be looking for more than nerve blocks.
The question of surgery. “Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all.”
A 2016 study (2) opens with this description of Occipital neuralgia:
“Occipital neuralgia is defined by the International Headache Society as paroxysmal (SUDDEN) shooting or stabbing pain in the dermatomes (area) of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily.
More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures.
Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.”
This is why surgery should only be explored after careful consideration.
That one spot in the neck – the search for an active trigger point in treating headache, migraine, and Occipital Neuralgia
Headaches and migraines can have many causes. In my practice the cause we focus on is ligament and tendon damage that creates active trigger points. During the course of a physical examination we palpate the neck area, gently searching for a spot on the skin to press that will cause a pain signal or “trigger point.” This is where we will need to focus treatment on. A 2017 study in The Clinical journal of pain (3) demonstrates that migraine headache could be reproduced by finding and palpitating (gently pressing) these active trigger points. These trigger points were found in the splenius capitis (the muscle at the base of the skull), the upper trapezius (the big back muscle that extends into the back of the neck), and the sternocleidomastoid muscles (among the biggest muscles that move the neck and attach at the back of the head). The theme of course is muscles at the back of the head.
Trigger points can be caused by stress and tension in the muscles created by damaged muscle tendon attachments and damaged cervical spine ligaments. In addition to tendon attachments causing neck instability and leading to muscle spasms and migraines, our own clinical observations of more than 20 years coupled with that of numerous research studies have demonstrated that damaged, weakened cervical neck ligaments cause head postural problems which lead to tension, stress and pain in the neck which in turn creates generates headaches.
- Ligaments are the soft connective tissue that hold the vertebrae in place. When these ligaments are damaged they allow for unnatural movement of the vertebrae. This can lead to “pinched nerves,” “muscle spasms,” and tension / stress on the cervical muscles.
TREATING CERVICAL LIGAMENTS AND TENDONS WITH PRP AND STEM CELL THERAPY
PRP and stem cell therapy addressed weakened physical structures in the cervical spine. This includes the ligaments and tendons. The goals of these treatments is to regenerate and repair these structures.
Platelet Rich Plasma injections
PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the cervical spine area at the tendon and ligament attachments and regeneration. Research has shown PRP to be effective in treating degenerative disc disease by addressing the problems of cervical spine ligament instability and tendon attachment damage.
Stem cell injections
Stem cell injections involve the use of Bone Marrow derived stem cells.The stem cell treatments help restore ligaments strength by causing the regeneration of ligament, tendon, cartilage and bone regeneration.
Can stem cells reduce migraine headache attack through its reparative anti-inflammatory properties?
A study published in the journal Case reports in neurology (4) suggests that stem cell therapy may be effective in treating refractory chronic migraines.
Here the researchers noted:
- “These case reports of patients afflicted with refractory chronic migraines suggest that some such patients may improve with stem cell therapy. Stem cells may relieve migraines through their proven anti-inflammatory properties because neurogenic inflammation is one of the major aspects of migraine pathogenesis.”
Do you have questions? Ask Dr. Darrow
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Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.
1 Kuhn WF, Kuhn SC, Gilberstadt H. Occipital neuralgias: clinical recognition of a complicated headache. A case series and literature review. Journal of orofacial pain. 1997 Apr 1;11(2).
2 Choi I, Jeon SR. Neuralgias of the head: occipital neuralgia. Journal of Korean medical science. 2016 Apr 1;31(4):479-88.
3 Florencio LL, Ferracini GN, Chaves TC, Palacios-Ceña M, Ordás-Bandera C, Speciali JG, Falla D, Grossi DB, Fernández-de-las-Peñas C. Active trigger points in the cervical musculature determine the altered activation of superficial neck and extensor muscles in women with migraine. The Clinical journal of pain. 2017 Mar 1;33(3):238-45.
4. Mauskop A, Rothaus KO. Stem Cells in the Treatment of Refractory Chronic Migraines. Case Rep Neurol. 2017 Jun 14;9(2):149-155. doi: 10.1159/000477393. PMID: 28690531; PMCID: PMC5498934.