**5. Conclusions**

Select migraine headache patients, occipital neuralgia patients, and NDPH (New Daily Persistent Headache) patients can be successfully treated by surgical intervention. However, they should also be simultaneously seen by a neurologist, who can manage medications and rule out other diagnoses apart from migraine headache. Typically, these patients also have failed multiple classes of traditional conservative treatments. Careful documentation, such as patient migraine diaries, should be kept to track changes. Upon confirmation of migraine headache, various trigger sites can be identified by a constellation of symptoms and chemical denervation. Patients with severe anxiety and depression, medication overuse, and narcotic use respond poorly to surgery. Therefore, maximizing medical treatment by neurology following surgery is essential. Surgical decompression for treatment of migraine pain has proven significantly useful by multiple studies, both controlled prospective and retrospective [7].

Currently, surgical intervention becomes a viable option after complete exhaustion of other treatment methods. Rates of complication are low and potential benefits are life-changing. This small group of patients who do not respond to the available preventative and abortive treatments are often left with a very low quality of life. As a result, surgery is often the last resort for an effective treatment and potential permanent relief from their symptoms. In the future, further multicenter randomized prospective trials can elucidate which patients maybe better candidates and improve the response rate.
