1. Nonsurgical Options
Medications and a set of three steroid injections, with or without botulinum toxin, can "calm down" the overactive nerves. Some patients respond well to non-invasive therapy and may not require surgery; however, some patients do not get relief and may eventually require surgical treatment.
There are other treatment options such as burning the nerve with a radio-wave probe or eliminating the nerve with a small dose of toxin. However, these are not always the best choice since either treatment can permanently deaden the nerve, resulting in scalp numbness.
2. Surgical Options
Surgical options include decompression of the greater occipital nerves along their course, called occipital release surgery.
In this outpatient procedure, the surgeon makes an incision in the back of the neck to expose the greater occipital nerves and release them from the surrounding connective tissue and muscles that may be compressing them. The surgeon can address other nerves that may be contributing to the problem, such as the lesser occipital nerves and the dorsal occipital nerves.
The surgery generally takes around two or three hours and is performed with the patient asleep under general anesthesia. Patients are able to go home the same day, and full recovery is generally expected within one or two weeks.
In some cases, occipital release surgery only works temporarily, and the pain returns. Further surgery to cut the greater occipital nerves can be performed after about a year, however, this procedure is regarded as a last resort since it would result in permanent scalp numbness.