At MedStar Southern Maryland Hospital Center, our surgeons are experts in diagnosing and surgically treating various headache disorders, including migraine headaches, cluster headaches, post-traumatic headache conditions, and occipital neuralgia.

Headache Disorders

The causes of such conditions can be very complex, and many patients spend years chasing treatments. Our surgeons receive additional training focusing specifically on nerves, to ensure that you receive the best possible care from top experts in the field, and often use treatments such as the following:

  • Pharmacological: Patients often benefit from both a preventive and abortive medication treatment plan. A daily preventive medication will help make headaches less severe when they do occur. These include antidepressant, anti-seizure, and antihypertensive medications. An abortive medication is a single medication or a combination of medications that is taken during an attack. These include NSAIDS, triptans, ergotamines, antiemetics, and antipsychotics.

  • Nerve blocks: In this procedure, anesthetic agents (a mixture of lidocaine and bupivacaine) are injected near the occipital nerve on the back of the head near the base of the skull. Most patients have no side effects; some patients experience pain at the injection site and/or dizziness.

  • Botox: These injections are used primarily on patients who experience chronic daily headaches.

  • Nerve decompression surgery: This procedure is reserved for patients who experience occipital neuralgia or chronic daily headaches. For patients with chronic migraines who do not find relief with medications or lifestyle changes, peripheral nerve surgery may be the answer.

Migraines: Common Causes and Factors

Migraines have a strong genetic component with 70 percent of patients having a first degree relative with a history of migraines.  In addition, more women than men suffer migraines.

Many people associate their migraines with factors such as:

  • Stress
  • Hormonal changes
  • Contraceptive use
  • Pregnancy
  • Ovulation
  • Lack of sleep
  • Head trauma
  • Changes in weather
  • Smoking,
  • Ingesting red wine
  • Exposure to computers or bright lights

Migraine Treatments

Holistic Solutions 

  • Sleeping in a dark, quiet room
  • Relaxation exercises; yoga
  • Acupressure treatment

Lifestyle changes can also help patients with migraines, including avoiding the key agent/triggers and learning how to deal with stressful situations, eating healthy, and sleeping at least eight hours per night. 

Pharmaceutical Remedies

  • Aspirin
  • Antidepressants
  • Anti-seizure medications or calcium blockers
  • IV medications (if hospitalized)
  • Short courses of steroids

Note: Narcotics are never a good treatment for a headache.

New Innovations

  • Occipital nerve stimulation
  • External trigeminal nerve stimulation
  • Gammacore handheld device
  • Antibody therapies


If you suffer from chronic pain, headaches or migraines that present in the front, side or back of your head (or any combination) and are not finding relief through medication or other treatment options, you may be a candidate for migraine surgery.

Criteria for surgery include:

  • Chronic headaches, migraines or occipital neuralgia occur despite medical care provided by a headache-specialized provider, such as a neurologist or pain specialist.
  • You have followed the treatment plan outlined by your neurologist or pain specialist for at least six months.
  • Your neurologist or pain specialist ruled out other possible causes of your headaches or migraines using diagnostic tools such as blood work and magnetic-resonance imaging (MRI) scan.
  • Medical treatment was ineffective, or caused negative side effects, preventing you from continuing to take them.
  • You experienced relief, even if temporary, from peripheral nerve blocks, such as an injection of numbing medications around these peripheral nerves.
  • You have tenderness on selective nerves in the back, front, and/or the side of the head.
  • Your medical treatment has plateaued in providing complete relief.

People with chronic headaches can be treated with outpatient surgical procedures. Many patients who experience long-lasting, debilitating headaches experience complete headache relief following peripheral nerve surgery. Others have partial, but significant, relief. Unfortunately, some headache sufferers are not candidates for this surgery.