| Objectives To observe the changes of headache characteristics, daily work and life, mental state and sleep quality of patients before and after operation, to understand the efficacy of greater occipital nerve decompression in the treatment of occipital migraine, as well as the safety and side effects of this procedure in clinical practice.Methods Choose 63 cases of occipital migraine patients received during April 2013 to June 2015(including 18 cases of patients who suffered bilateral posterior occipital pain), 23 cases of male patients and 40 female patients; aged 16-68 years old, average 45 years old;the course of disease was 10 months to 38 years, average 14 years. This group of 63 patients are in line with the International Headache Society to develop the International Headache Classification Third Edition(beta version)diagnostic criteria, they are allpersistent or paroxysmal occipital pain. The headache of all patients were reduced after the greater occipital nerve block. All the patients accept greater occipital nerve decompression under local anesthesia. Follow up for 6 months. Use visual analog scale,self-made headache duration and attack frequency table, headache impact test-6 form, selfrating depression scale, the 14-item Hamilton anxiety scale and Pittsburgh sleep quality index to score condition of patients. Then use SPSS19.0 statistical software for data analysis.Results All the patients in this group were operated smoothly. The time of unilateral greater occipital nerve decompression was less than 30 minutes. Intraoperative findings:The greater occipital nerve trunk from inside out through the above semispinalis divided into 3-5 branches. The occipital artery went through the Broad neck muscles from lowlateral side to upper-inside. It is tortuous or ansiform through the bifurcation of the greater occipital nerve. Enlarged lymph nodes near the trunk or major branches of the occipital nerve. In terms of the degree of pain, duration, frequency of attack, The sixth months after the operation were significantly improved than before surgery(P<0.05).There is no patients with headache aggravating after operation. In general working life affected by the degree of headache, The first months and sixth months after operation were significantly improved compared with before operation(P<0.05),Further improvement was made sixth months after surgery compared with first months after surgery(P<0.05). In the state of mind, There were 7(12.3%)patients with mild depression before operation, 1(1.8%)patients with moderate depression, 23(40.4%)patients may have anxiety, 9(15.8%) patients with mild anxiety, 1(1.8%)patients with moderate anxiety. The depressive state of the patients was not significantly improved first months after operation(P>0.05). Significantly improved after sixth months of operation(P<0.05). The anxiety state of patients was not significantly improved after first months of operation(P>0.05). Significantly improved after sixth months of operation(P<0.05). In terms of sleep quality, Before operation, there were 29(50.9%)patients with sleep problems. Sixth months after the operation, there were significantly improved compared with before operation(P<0.05). In particular, there was a significant improvement in subjective sleep quality, sleep time, how long to fall asleep and sleep efficiency.Conclusions Occipital migraine is generally a chronic, episodic headache, drug treatment is difficult to cure, seriously affect the normal work and life of patients, Often causes the patient to be depressed, serious when the patient will appear anxiety, depression and sleep disorders, etc. Greater occipital decompression is an ideal treatment as it uses local anesthesia with short operation time, less side effect and high efficiency. It greatly improved the quality of life, work status, mental state and sleep quality of the patients. It is possible to become the first choice for treatment of migraine headache in the future. |
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