Curriculum
October 6, 2021

TRIGGER POINT INJECTIONS vs NERVE BLOCKS – WHAT’S THE DIFFERENCE?

Simple question, somewhat nuanced answer. Basically, nerve blocks are injections of local anesthetic aimed at temporarily and chemically inactivating a nerve - pure and simple.  Where things get a bit…
Curriculum
September 8, 2021

THE STAGED APPROACH TO CHRONIC HEADACHE/MIGRAINE RELIEF

I was recently asked why some people require more than one operation to obtain optimal relief.  A great question and one with a multi-part answer.   Let me try to break it down…
Curriculum
August 16, 2021

MEDICATION OVERUSE HEADACHE (MOH) OR ‘REBOUND HEADACHES’

I have been asked recently to write a little something about so-called “rebound headaches”. This topic can be quite confusing, and as you will read, is not very well understood.…
Curriculum
August 16, 2021

THE NERVE WAS CUT, BUT I STILL FEEL THAT AREA – HOW IS THAT POSSIBLE?

Over the years, I seem to have had this question come up on a fairly consistent basis and the answer is actually relatively straightforward.  Let’s take as an example, an…
Curriculum
July 8, 2021

TO DECOMPRESS OR TRANSECT: THAT IS THE QUESTION

This query is one of the great ones – a $64,000 question that continues to be raised both in my office as well as online.   What is the difference…
Curriculum
July 6, 2021

CAN STRESS MAKE OCCIPITAL NEURALGIA WORSE?

This question is one of the most common articulated in my office and I believe represents an underappreciated component of our everyday lives that can certainly impact many facets of…
Curriculum
June 19, 2021

Why We’re All Wired Differently

Take a look at the first picture- it is of a midline incision in the back of the neck.  Can you identify the nerve by the black arrow and the…
Curriculum
June 9, 2021

BLOCKS & STIMULATORS & DECOMPRESSION, OH MY?!?

I’ve noted that there has been some confusion lately over the roles of nerve blocks, nerve stimulators and nerve decompression in the treatment of chronic headaches. To be sure, there…
Curriculum
May 14, 2021

THE MRI WAS NEGATIVE… NOW WHAT?!?

As with many things in life, there are positive and negative ways to perceive just about anything.  Just because the MRI was negative, clearly does not mean that there is…
Curriculum
May 7, 2021

Why The Recovery Rollercoaster?

Perhaps one of the most common questions I get asked is, “What is recovery like?”  How much time do you have?  There are so many facets to this question that…
Curriculum
April 20, 2021

Why Do Nerves Take so Long to Recover?

I hear this question a lot from just about every patient I see, whether for chronic headaches or tarsal tunnel syndrome.  The answers have to do with the technical aspects…
Curriculum
March 9, 2021

How to Choose a Headache Surgeon

One of the first things to assess is whether your surgeon has formal and specific training in peripheral nerve surgery. Since the operationS for chronic headaches/neuralgia potentially involve many nerves…
Curriculum
March 9, 2021

Migraine or Neuralgia?

People often confuse migraine symptoms with something called neuralgia. The former refers to an often disabling neurological condition characterized by severe and sometimes frequent headaches. The latter literally means “nerve…
Curriculum
March 9, 2021

Which Came First, the Muscle or the Nerve?

Just this past week, several patients have asked about the tight muscles in their necks and upper backs. They have all wondered at some point whether it’s the tight muscles…
Curriculum
February 25, 2021

What is Temporal Neuralgia?

As I have written previously, neur-algia simply means ‘nerve pain’.  The question always becomes, can you figure out which ‘neur’ (i.e., nerve) is causing the ‘algia’ (i.e., pain).  Secondly, if…
Curriculum
February 25, 2021

What is Peripheral Nerve Surgery?

There are a number of ways to characterize and define the nervous system. First of all, the primary cells that comprise the nervous system are called neurons.  Groups of neurons…
Curriculum
February 25, 2021

What is Frontal Neuralgia?

As before, neur-algia simply means ‘nerve pain’.  The question always becomes, can you figure out which ‘neur’ (i.e., nerve) is causing the ‘algia’ (i.e., pain).  Secondly, if you can figure…
Curriculum
February 17, 2021

If I’m a Candidate, How Is Surgery Performed & What Are the Outcomes?

Surgical intervention (whether decompression or neurectomy/muscle implantation) for chronic headaches is performed as an outpatient procedure at an accredited surgery center or in the outpatient department of the California Pacific…
Curriculum
February 17, 2021

How & Why Did I Get Occipital Neuralgia?

The title of this post represents the million dollar question.  I have posted many times in the past about how ON can be caused by compression from spastic neck muscles,…
Curriculum
February 17, 2021

Is Permanent Relief From Chronic Headaches Possible? YES!

Migraine headaches have traditionally been thought to arise from within the central nervous system (i.e. the brain and/or spinal cord) and then produce symptoms elsewhere such as throbbing in the…
Curriculum
February 17, 2021

Whiplash & Occipital Neuralgia: What’s the Connection?

I am asked routinely about the relationship between whiplash and occipital neuralgia.  First of all, what is whiplash?  Simply put, it is a sudden jerking of the head, usually in…
Curriculum
February 17, 2021

Why Use Nerve Blocks?

Nerve blocks are very powerful tools in helping to determine whether or not a particular person is a good surgical candidate. Nerve blocks are simply injections of local anesthetic which…
Curriculum
February 17, 2021

Transforming Headache Care

Chronic headaches such as migraines remain a huge burden on the American healthcare system accounting for tens of billions of dollars in both direct and indirect costs annually.  What’s more,…
Curriculum
February 17, 2021

What is a Migraine?

Many people consider a migraine to be a really bad headache. The truth is it is a severe, neurologic condition. However, when perusing the medical literature, it becomes apparent that…
Curriculum
February 17, 2021

Neuroplasticity and Central Sensitization

In this post, we discuss two important terms, ‘neuroplasticity’ and ‘central sensitization’.  Neuroplasticity refers to the amazing ability of the brain to change and adapt in response to interactions of…
Curriculum
February 1, 2021

What are Nerve Blocks?

The term ‘nerve block’ refers specifically to an injection of local anesthetic that is aimed at inactivating a nerve.  These blocks typically work by chemically and temporarily disabling a nerve’s…
Curriculum
February 1, 2021

How Was This Concept Discovered & Where Are These Nerves Located?

Believe it or not, the idea of a peripheral nerve causing your headache dates back as far as 1000 A.D. when one of the founding fathers of surgery (Al-Zahrawi) first…
Curriculum
February 1, 2021

What is Neuroplasticity?

In this post, we discuss two important terms, ‘neuroplasticity’ and ‘central sensitization’. Neuroplasticity refers to the amazing ability of the brain to change and adapt in response to interactions of…
Curriculum
February 1, 2021

It’s the Fascia, Silly

The covering of muscles in humans is called fascia (pronounced fah-sha).  It consists of a very tough, fibrous layer of connective tissue that surrounds the muscle itself.  What does that…
Curriculum
March 8, 2020

Can Stress Make Occipital Neuralgia Worse?

This post will be a relatively short one, but this question is very important.  I have been queried about this phenomenon numerous times in the office and while lecturing to…