Now I see the two different articles — an interesting read, definitely.
Let me be clear so i don’t seem like I’m on “the wrong side” – I personally fully believe IJV compression is a real problem for many people. I hope my conversations with especially @Isaiah_40_31 and @Jules also gives this impression. I don’t think the people getting better after these IJV decompression surgeries are just imagining it, and I think that the IJV actually is the main culprit often, and I think the doctors dismissing it are wrong. Even though some people — maybe like myself with IJV compression — might get better from removing the styloid so it no longer compresses the nerves, I am sure that the many patients who only get the IJV decompression (Dr. Costantino’s patients for example, who only does C1 resection/soft tissue) and get better is because of the IJV alone being a problem.
However, the first study is essentially a critique of current methods, arguing that we may have been asking the wrong questions all along — which I personally find convincing — but a sceptical doctor could reasonably say it doesn’t prove anything on its own.
The second article (which I can now read) doesn’t prove anything in the “hard scientific sense” that local doctors care about either, as they can only operate within the limits of strict evidence (which differs from privately paid hospitals). This is a useful article and probably points in the right direction, but it cannot really be used as hard scientific proof. By the authors’ own admission, all included studies are case reports and small single-centre cohort studies — there are no randomised controlled trials, no control groups, and no placebo adjustment. That means sceptical doctors can still argue that some of the improvements were just placebo effect, natural recovery, or coincidence. They can especially argue that the benefits didn’t come from decompression of the IJV, but simply from having the styloid removed — so it no longer irritates the nerves and surrounding tissue. The 80% success rate from styloidectomy alone sounds great, but it comes from only 96 patients spread across many different studies, which is a pretty small number to draw firm conclusions from. It also doesn’t prove that IJV compression actually caused the symptoms in the first place. Even in the cases where styloidectomy did help, we don’t really know why it helped — and this is actually the key point for the local doctors. They don’t dispute that styloidectomy helps people, and they accept that an elongated styloid can cause problems by mechanically pressing on nerves and surrounding tissue. What they specifically question is whether the venous compression itself is the active mechanism — because that part still lacks harder scientific evidence.
To be clear again, I am personally 99.9% sure that IJV compression itself is a significant issue — and most likely a significant issue for me specifically, which is why I would only ever consider a styloidectomy if the styloid is removed fully to the skull base, giving me at least a chance of achieving decompression.
In countries with strict evidence-based healthcare systems, they simply don’t offer this surgery routinely for IJV compression — not because the research is worthless, but because it hasn’t cleared the bar they are required to work within. This doesn’t change the fact that the local doctor isn’t stupid, and it’s not as though she outright says there is absolutely no possibility that a compressed IJV could be causing problems — even if she thinks it rarely does in people who happen to have some degree of IJV compression. This is also the reason why she said she could try during surgery to decompress it a bit (which they often do in some ways further down by removing lymph nodes and so on), but there is no way she is going to cut the occipital artery, remove the posterior belly of the digastric muscle, or touch the C1 — which is why I would not let her attempt any further decompression if she were to operate on me, aside from doing a styloidectomy to the skull base. My understanding is also that this makes revision surgery easier, as there will not be scar tissue near the C1/IJV in the same way as if she had also attempted a full decompression. I’m still more than 90% sure that I will go straight for the full decompression surgery though, as I would without a doubt never rest until my headache is either gone or I know for certain that my IJV compression is not the cause. The local surgeon seems to understand this though.
A bit of a rant, I know… Just needed to be clear what the situation is and I’m grateful for all the help here 
