Novel Concepts in Headache Surgery: Case Report Incorporating Interdisciplinary Care for Complex Head and Neck Pain with Cervical Dystonia

Complex cases of head and neck pain may involve overlapping disorders such as occipital neuralgia, chronic migraine, cervical dystonia, peripheral and central sensitization, and complex regional pain syndrome of the head. In these cases, traditional nerve decompression techniques may not provide adequate symptom relief, and advanced multidisciplinary treatment involving conservative, minimally invasive, and surgical measures may be necessary. This case report illustrates novel concepts in headache surgery that have not been previously described to address complex pain in the head and neck region. We described a patient refractory to prior treatment in whom a multimodal approach to complex pain was used to manage different types of symptoms. This included (1) migraine management by neurology; (2) pain medication, injectables, and electrostimulation administered by pain management; and (3) nerve decompression, neuroma excision with nerve end reconstruction, and neurectomy (for cervical dystonia) performed by plastic surgery. The patient experienced resolution of occipital pain, reduced migraine frequency, and improvement in cervical dystonia, and was successfully weaned off opiates. Interdisciplinary care is required for patients with complex head and neck pain. Complex regional pain syndrome of the head and neck can be resolved by addressing multiple peripheral nerve involvements. This approach can significantly relieve symptoms in patients who have previously been considered refractory to treatment.