M.I.G.O.N.E. is a treatment for migraines and occipital neuralgia associated or triggered by occipital neuralgia. The root cause of occipital neuralgia is the entrapment of the occipital nerve within the muscle tissues surrounding it.

Pain is caused by the swelling or tightness of muscles and other tissue, like your fascia, around the occipital nerve, entrapping it and causing pain. With the M.I.G.O.N.E. procedure, the surgeon removes a small bit of muscle and other tissue to free the nerve and allow it to function normally.

Multiple trigger point sites can be safely addressed in a single procedure.

For patients who don’t respond well to other treatments, migraine surgery may be the way to restore the quality of life. The M.I.G.O.N.E. procedure is recommended to reduce headache and migraine frequency, intensity, and/or severity.

Occipital headaches originate in the back of the neck where the nerve may be entrapped by a muscle called the semispinalis capitis muscle. Surgery is performed to remove part of the muscle and shield the nerve from further irritation. Muscles adjoining the nerve at other points may cause pain elsewhere in the head and neck. In all cases, the condition is termed occipital neuralgia or ON.

Occipital Neuralgia

The greater occipital nerve provides sensation for much of the back and top of the head. Occipital neuralgia is a common pain associated with the back of the head and neck, with pain spreading as far forward as the eyes.

The occipital nerve is a common trigger for migraines.

Occipital neuralgia has several potential causes:

  • Traumatic events such as an auto accident or a fall
  • Whiplash injury causing inflammation in the head and neck region
  • Osteoarthritis of the upper cervical spine
  • Tumors affecting the nerve roots
  • Blood vessel inflammation
  • Gout
  • Infection

Occipital neuralgia is typically diagnosed by examining the patient’s medical history, how long the patient has experienced symptoms and potential underlying conditions. The physician may order an MRI or CT scan to rule out other conditions. In most cases, the neurologic exam shows no abnormalities, and the pain is only caused by the neuralgia.

Occipital neuralgia is differentiated from migraines by the symptoms it causes. Occipital neuralgia causes a sharp pain in the area of the nerve while migraines are characterized by recurrent headaches that can last from two to seventy-two hours. Occipital neuralgia may respond to various treatments differently than migraines.


Migraines have been associated with the compression and irritation of nerves in the face and head, including the occipital nerve. The migraine triggers may be chronic, genetic, or the result of changes that take place as we age.

The M.I.G.O.N.E. Procedure

The M.I.G.O.N.E. procedure takes approximately two to three hours and is generally performed as an outpatient procedure. The surgeon removes enough tissue (muscle, fascia, and blood vessels) surrounding the occipital nerve to create more space so it can function normally and without pain.

Surgery is considered when initial medication treatments are ineffective or lose effectiveness over time. It may also be considered if the side effects of the medication outweigh its benefits, causing the patient to discontinue treatment.

BOTOX is effective but is not a permanent solution. However, treatment can help pinpoint the locations to address during surgery.

M.I.G.O.N.E. is a minimally invasive surgical procedure, and every surgery involves risk. You may experience side effects or complications. If you have any questions or concerns, be sure to discuss them with your physician.

Contact our office to set up an evaluation with a migraine specialist at The Migraine Relief Center.

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