Back to all discussions

Radio Frequency Ablation or nerve decompression surgery?

I've not had success with the procedures my headache neurologist has provided, except for his acute care and a 1 week and 5 day complete relief from migraines after trigger point injections.

My dr. Said I need to try Botox "his way" (I' had it for three years at another neuro's office with no success). If that doesn't work, he's going to send me to a plastic surgeon for radio frequency ablation and/or nerve decompression surgery.

Has anyone had these procedures? My migraines seem to be mainly triggered by moving my neck too much (turning to the side to look out the car window for three to five minutes will give me a migraine). The pain starts at the base of my head in the occipital area and spreads around to the sides of my head. At other times, I will have pain originating in my temples and areas on the side close to there, and then my head will hurt anywhere something touches it. So it's like I have two separate types of migraines.

I'm looking to hear from anyone who has similar experiences and had one or both of these procedures done. I've read a lot of mixed information in the scientific articles on these procedures, and I've read little of what the recovery from these procedures is like. The only thing I've heard is from my dr, who said my neck would be sore for a few days after radio frequency ablation.

Any information would be welcome! Thanks,


  1. Hi Michelle,

    Thanks for your question, let me see what I can do to help. In my honest opinion, before I had invasive either procedure, I would seek out the help of an expert, a migraine/headache doctor. These doctor are different from neurologists because they are board certified in headache medicine, whereas all neurologists are not. Neurologists are fine doctors but have a hard time being experts in one area because they treat so many different conditions such as multiple sclerosis, epilepsy, stroke, Parkinson's and others. Migraine and headache experts are just that, experts who treat one condition, migraine and headache all day, every day. Let me share information with you on how these doctors are so special and how to find one; and

    In the event you go down the surgery route, we have information on this too; and and

    I hope this helps,

    1. Thank you Nancy. I am under the care of a migraine neurologist. All he does is migraines. He even has patient rooms for people trying to break their migraines through drug therapy. He's been very helpful and tried lots of procedures. He only recommended surgery after trying trigger point injections, nerve blocks, preventative medicine, and an epidural spinal patch. Trust me, I wouldn't be letting just any old doctor tinkering in my head.

      I will check out your links shortly!


      1. I've had radio frequency ablation. Last year by a pain management doctor. It did nothing at all. Talking with other doctors, I have had great short term success with facet injections so the ablation should have helped. Turns out it seems it is very difficult to find the occipital nerve as it does not show up on the screen he uses to guide the needle. Just a big blank space. Nerves don't show like bones.
        I remember him asking me if "that" was the place. I am now under a neurosurgeon for my facet injections and am waiting to be scheduled for an ablation by his office. It's not bad, no worse than the facet injections. Prayers to you. I'm also very very close to giving serious consideration to the nerve decompression surgery. I've had enough!

        1. Hi Michelle,

          I have not had radio frequency ablation, but I am moving in that direction. I have worked with the Michigan Head Pain and Neurological Institute for many years, until two years ago when I shifted to a local neurologist who specializes in migraines. Most of my time with MHNI involved a rotation of every preventative medication and combination of medications. Toward the end of my active relationship with MHNI I went through their outpatient IV infusion program as well as their inpatient program. Neither brought about any long lasting relief. The last treatments I received through MHNI were a series of three bilateral C2 nerve blocks. Each of these brought about complete relief from migraine for one to two full days. This does not sound like much, but for me (my migraines are daily, literally every day) that was significant. The physician at MHNI wanted to move forward with RFA, as the three nerve blocks showed that he had "hit the spot" so to speak. Unfortunately my health insurance at the time, Blue Cross and Blue Shield of Michigan, repeatedly denied the procedure. Paying 100% out-of-pocket was not feasible. So, I moved from MHNI to working with the local neurologist, who had been performing Botox injections throughout the last year or so I was working with MHNI. Additionally, I also worked with an acupuncturist as well as a physical therapist who does myofascial release.

          The last several weeks have brought about a painful increase in the intensity and duration of my migraines. I, thankfully, just got another round of Botox injections last week. I am hopeful that the Botox will have some positive impact.

          Also along the way my health insurance has changed to Priority Health. I am currently waiting on a call back from the MHNI team member that handles all the insurance pre-authorizations for procedures, including RFA. At our last conversation she had indicated that I should call if and when I was ready to move on the RFA.

          So, although I cannot speak of having actually had RFA I am definitely ready to proceed with the procedure if I can get my health insurance to approve it. In fact, even if they do not I may try to work out some kind of payment arrangements with MHNI and Chelsea Hospital. I just cannot stand the daily migraines any longer!

          Speaking of nerve decompression surgery... I brought this up with my neurologist last week during my visit for the Botox injections. We talked about the procedure a bit. She had not heard much of the procedure. None of her migraine patients had this surgical procedure. She mentioned attending CME sessions, lectures and classes where treatments and procedures were discussed. She said that nerve decompression had not been high on any list of such discussed treatments. I am not sure how much weight, if any, that carries.

          As the visit came to an end my neurologist suggested I pursue the RFA and, if that shows results, moving toward a stim-implant. She seemed to believe this would be the best path considering the chronic nature of my migraines and the long history I have of failed treatments.

          So, my plan is to try and get the RFA. From there I will decide what makes sense next. In the interim, I am hoping that the Botox injections will ease the duration and intensity of the migraines a bit.

          I will definitely post here as I move down this path!

          Take Care,

          or create an account to reply.