Peled Migraine Surgery Blog

Information and knowledge about migraine relief surgery.

Trigger Point Injections Vs Nerve Blocks - What's the Difference?

This question is a very interesting one. Basically, nerve blocks are injections of local anesthetics, pure and simple.  Where things get a little more complicated is the amount and type of local anesthetic used and if it is mixed with anything else.  Each type of local anesthetic has a distinct pharmacologic profile primarily affecting the duration of action and onset of action of the drug. Two common types of local anesthetic are lidocaine - quick onset, short duration and Bupivacaine (AKA Marcaine/Sensorcaine) - longer onset, but much longer duration of action. Sometimes these agents are injected by themselves and sometimes they are used together with or without epinephrine (to prolong the duration of action). Oftentimes, nerve blocks also include steroids (e.g. Kenalog) which are intended to reduce inflammation locally.  Typically when people add steroids they are using the blocks as treatments, not as diagnostic tests, but like any medication, the effects are often temporary (a few days to a few months) and then the symptoms typically return. Steroids also have side effects that preclude their use chronically and at too high doses. Local anesthetics are usually metabolized within a few hours so theoretically, you could have one every day without any long-term problems (not done in practice except perhaps at Guantanamo Bay ).

Trigger point injections are a bit trickier.  They are, in my opinion, relatively poorly defined, but basically consist of a focal infiltration of local anesthetic +/- steroid in the soft tissues in an area of pain (i.e. the trigger point).  Unlike nerve blocks which are supposed to be used to block specific nerves (hence the name), trigger point injections are used within muscle or other soft tissue to treat pain by modulating local pain signals in some other way.  Practically speaking, trigger point injections are used to as treatments in the hopes that blocking the pain signals in this other way will lead to some permanent degree of relief.  

So why so some people require one shot and others 10?  Well, it depends on what’s being done and the pathology being addressed.  I don’t do trigger point injections since frankly, I’ve not seen a definitive explanation regarding exactly how they’re supposed to work or why they’re supposed to work so I’ll speak to nerve blocks.  If you come to my office and based upon your history and physical exam I think you have right sided greater occipital neuralgia, I will block the right GON.  If I’m correct, the 10/10 headache you came in with will be significantly better if not gone just by blocking that one nerve.  If, however, I think you have bilateral greater, lesser and third occipital neuralgia, I will tell you ahead of time that you might require three sets of shots in that session.  The first set of shots will be in what I deem to be your primary source of pain.  Let’s say your headache is 10/10 and I think that your primary source of pain is the GONs - I will inject those and wait 10 minutes.  If your headache disappears, I’m done.  If your headache only gets 33% better, now I’ll inject another potential source, let’s say the LONs.  If your headache is now gone, I will operate on both the GONs and LONs since blocking both gave you incremental and total or near-total relief.  If you’re only 66% improved, I will inject the third occipital nerves and if now your headache is gone, I have to operate on all three nerves bilaterally.  You cannot inject all three nerves on both sides at the same time, because if you get complete relief after injecting all at once, you literally have no idea which nerve block gave you that result. Therefore, the number of shots with regard to nerve blocks depends on: how many nerves you think you’ll need to knock out to get the result you hope to achieve with an operation and your injection technique/experience.  For more information, please visit www.peledmigrainesurgery.com today and call 415-751-0583 or 925-933-5700 to talk to us directly!

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More Information On the Occipital Artery and Greater Occipital Nerve

That's not a brain, it's the soft tissues of the neck after a melanoma resection. What I'm showing in the video is the occipital artery which is pulsating if you look closely enough. Right next to this artery is the greater occipital nerve. You can see them clearly since the oncologic surgeon had to make a big hole, but you also notice that these two structures lie right next to one another. Therefore, without this big hole and if the space between these two structures is narrowed by scar or an enlarged vessel, that artery would be constantly banging against that nerve and can cause a lot of pain - i.e. occipital neuralgia.

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WHAT CAUSES OCCIPITAL NERVES TO MALFUNCTION?

As I have posted several times in the past, the occipital nerves can be compressed by a number of different structures such as blood vessels (e.g. the occipital artery), fascia, scar and muscle.  But someone recently asked me how these structures can cause pathologic changes in the nerve so I thought I’d put down a few thoughts.  First, there are changes that can occur after injury whether surgery or a stretch injury as one would get with “whiplash” (see post: “Whiplash and occipital neuralgia: what’s the connection?”, 01/21/14).  Many of the post-surgical changes are detailed in my more recent post, “WHY DO NERVES TAKE SO LONG TO RECOVER?”, 04/29/14) and will not be repeated here.  So what happens to a nerve after prolonged compression?

 

CaptureWell, way back in 1995, some of the first peripheral nerve surgeons were able to demonstrate exactly that in a non-human primate model.  They induced carpal tunnel syndrome in cynomologous monkeys and then biopsied the nerves at various time points thereafter.  They then also looked to see what happens when those same nerves were decompressed.  The results are seen in the attached picture.  In the upper left “normal”, you see a biopsy of the median nerve in a non-compressed animal.  The black rings are the thick myelin sheaths that surround the white spaces which are the nerve fascicles themselves and help the nerves conduct impulses more efficiently.  After six months of compression (upper right) you can see that the myelin sheaths are already beginning to thin out and the nerves no longer conduct as quickly.  Clinically that may manifest as intermittent numbness and tingling and on EMG you are likely to find prolonged conduction velocity.  With prolonged compression (12 months, bottom left) you not only see further thinning of the myelin sheaths, but fewer numbers of nerves (white spaces surrounded by thin black rings).  Now you may clinically have constant numbness and the EMG may find decreased amplitude since there are fewer nerve fibers actually conducting impulses. You can imagine what would happen if the nerve were left alone even longer.  After decompression (bottom right) you can see that the myelin sheaths never fully return, but the number of axons (nerve fibers) increases as the nerve recovers.  

 

So what does this have to do with ON?  The answer is that it really doesn’t matter what’s compressing the nerves (muscles, discs, fascia, blood vessels) the long-term effects are the same as those noted above.  Has this been proven directly for the greater occipital nerve, for example, - no, but there is no reason to suspect that the sequelae of compression of peripheral nerves in the head/neck would be different than those at the wrist. Therefore it stands to reason that if there is mechanical compression on a nerve, all the medicine in the world won’t relieve that pressure - it has to be removed.  If that is done within a timely fashion, the nerve could recover, if not, it won’t. How much pressure is too much and how much time is too much?  Those are questions we don’t have answers to and I’m not sure we will any time soon.  However, for most people suffering from the often debilitating pain of ON, it cannot be soon enough.  For more information on peripheral nerve surgery, visit us at www.peledmigrainesurgery.com today!

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Worldwide Migraine Headache Relief

Do you have to live in the San Francisco Bay Area to get relief from your severe, chronic headaches? No, anyone may be able to achieve significant and lasting relief no matter where they call home! We have helped patients from all across the United States, and as far away as India and Brazil. We are excited to help people from all over the globe as peripheral nerve surgery is an area to which I have dedicated a large portion of my practice and is something about which I remain very passionate. We wish to extend an invitation to everyone anywhere to look us up and decide for themselves whether we might be able to help to reduce or eliminate their chronic headaches with peripheral nerve surgery.

I have performed hundreds of decompression procedures on nerves for chronic headaches with high success rates. Many of these people had been living with their headaches for decades and had resigned themselves to a life of chronic pain despite medication. Happily, we proved that was not the case. Furthermore, because we see so many foreign and out of town patients, we have developed a system to help make your overall experience as seamless as possible. We can assist with travel planning, lodging, transportation to and from the operating room and even post-operative nursing care if required. In addition, Dr. Peled is available for initial record review and evaluations via Skype or Google+ to help determine if a trip from home is a worthwhile endeavor. Finally, because post-operative follow-up is an extremely important part of the surgical experience and critical to achieving optimal outcomes, we use these same modalities to keep tabs on our patients after they have gone home and remain available to discuss issues with your local treating physicians if needed. This important time can be hard for patients as well as doctors that can't see their patients directly, but our practice has refined this process to ask the right questions and determine if any further action is needed.

So if you suffer from chronic headaches, please visit us at www.peledmigrainesurgery.com or call us at 415-751-0583 or 925-933-5700 to find out if we can reduce or eliminate your migraines. We look forward to hearing from you!

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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 of the surgical procedure, the physiology of peripheral nerves as well as the wound healing process itself.    As you can imagine, a compressed nerve is usually compressed on all sides because it is a three dimensional structure.  Therefore when decompressing a nerve, it has to be manipulated such that the superficial, deep, medial, lateral, cranial and caudal aspects of the nerve can be examined and released if necessary. In addition, there are often multiple compression points (the GON has up to 6 that have been described and often others that are noted intra-operatively).  Moreover, there are times when there is intra-neural scarring (scarring within the nerve, not just around it) which also requires removal.  Hence, there is a fair bit of manipulation usually required (albeit with microneurosurgical techniques) during any decompression procedure.

 

Axon -mediumAs part of the normal wound healing process, there is swelling.  The more neural manipulation required during the operation, the more swelling of the nerve you’re likely to have post-operatively.  I tell my patients to think of nerves as electrical wires, pure and simple.  All they do is conduct electrical signals back and forth, but it is the brain the interprets these signals as ‘hot’, ‘cold’, ‘painful’, ‘ticklish’ etc.  Therefore, if you think about pouring water into the drywall in your house near the electrical wires, it is likely that the lights will start to flicker on and off until the water dries up because the fluid is interfering with the electrical signals.  In the same way, swelling of the nerve can result in all sorts of “unusual firing” of the nerve and is one reason many patients may experience weird, sometimes painful sensations post-op.  However, if the nerves are going to recover, within a few weeks or months when the swelling has subsided, this “unusual firing” abates and the nerves “calm down”.  Just like with cutaneous scars (which also swell as part of the healing process) the time for swelling to decrease is usually longer than a few days or weeks.

 

Another reason why nerves may take a while to recover has to do with the severity and duration of compression.  I’m sure everyone has fallen asleep on their arm(s) at some point in their lives.  Sometimes, when you wake up, your hand is just a little numb and it takes about 10 seconds of shaking your hand to restore normal sensation.  Other times, however, when you wake up the entire arm seems paralyzed, weak and numb!  In these cases, aside from some transient agita, it takes up to 1-2 minutes of shaking the arm out for function and sensation to return fully.  Phew!  The difference between these two situations is that in the latter, the compression of the nerves to the arm has been present for longer and may have been more severe as compared with the former.  Therefore, it takes longer for sensation (and function) to return.  Now take that phenomenon and stretch the timeline out months and often years - that is how long many peoples’ nerves have been compressed.  Therefore, it can take weeks or months for function to return to “normal”.  Also, since the blood flow to the nerves in the latter scenario has been compromised for a longer period of time, they become more engorged with blood after flow is restored and then that extra blood takes time to return to its baseline levels.  It is for this reason that you often experience that sensation of tingling and pain after you remove pressure from the arm and as blood flow resumes. The same thing happens when blood flow is restored after decompression - (more intra-neural blood flow usually combined with more surgical manipulation).  Finally, since we don’t immobilize our heads after surgery (doing so would just stiffen all the joints), the nerves will glide right away after we do all of these things to them and also likely contributes to the recovery process. The take home message is that as patients and physicians, we have to be patient in assessing whether or not decompression has been successful as the final results may not be apparent for many months (as noted by many here).  After all, the same would true of a facelift or breast augmentation.  For more information, visit www.peledmigrainesurgery.com and call 415-751-0583 or 925-933-5700 to setup your appointment!

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Why Are Plastic Surgeons Doing Nerve Surgery?

There have been several comments recently about how it seems strange that plastic surgeons are the leaders in peripheral nerve surgery, specifically as it relates to chronic headaches. Many have wondered why this type of procedure is not performed by neurosurgeons as would seem intuitive. As with any questions, there are often several components to the answers.

First, let me start by saying that I am not a neurosurgeon nor is anything in this post intended to disparage neurosurgeons. Their profession is a difficult and exquisitely complex one, but like many fields within medicine, typically limited to specific areas of focus. While I'm sure that there are neurosurgeons out there who do peripheral nerve work, most those with whom I have interacted and worked focus exclusively on the brain and spinal cord. Indeed, pathology within these two body parts are complex enough and could keep any practitioner busy for the rest of his/her career. Therefore, while nerves exist throughout the body, if you’ve never operated outside of the brain, spinal cord or immediate paraspinal regions repairing a nerve in the forearm would be difficult for a number of reasons. One, the anatomy is foreign and there are many structures which are unfamiliar and can be injured inadvertently resulting in worse pathology. Two, it is well-known that peripheral nerves are distinctly different than nerves within the central nervous system and therefore medical/surgical treatments which may be effective in one area, maybe ineffective in the other. Third, the operation is only a part of the overall treatment of a patient hence a surgeon must be able to manage the expectations of the patient prior to the operation and any complications/issues that might arise post-operatively.  These skills require specific experience with specific procedures (see above).

Second, I should explain why plastic surgeons are uniquely qualified to perform peripheral nerve surgical procedures. Plastic surgeons are known for, among other things, being able to operate on all parts of the body. When we perform reconstructive or aesthetic procedures, we operate everywhere from the head to the feet. As part of our reconstructive training we are taught how to move and mobilize tissue from one part of the body to fill defects created either by surgery or trauma in other parts of the body. We therefore often run into peripheral nerves during these dissections and are familiar with their locations, anatomic variations and surrounding anatomy throughout the body. For example, one main sub-field of plastic surgical training is hand surgery which obviously involves many, very critical nerves. Approximately 50% of all hand surgical procedures performed in this country are performed by plastic surgeons. A few decades ago, several plastic surgeons, a little bit older and far wiser than I, began to ask themselves, ‘If nerves can be manipulated within the upper extremities and hands to relieve pain, provide sensation or restore function, why would it not be possible to perform similar types of procedures in the legs, trunk, head or neck for the same purposes?’ These pioneers adapted the surgical principals they were using in the upper extremities to these other parts of the body and for some it became the focus of their careers. It also soon became apparent that many of the principals that are applied, for example, to release of the median nerve in a patient with carpal tunnel syndrome can be applied to nerves within the foot and ankle in a patient who has tarsal tunnel syndrome. A second-generation of plastic surgeons luckily recognized the potential of these procedures, learned from the prior generation and continued their work. I’d like to also believe that we’ve been able to advance the field by applying established peripheral nerve surgical principles to yet other nerves which were once thought untouchable (e.g. I routinely see patients in my office with meralgia paresthetica who were told they would have to live with their pain forever),  but have now been successfully operated upon.  In addition, we have tools that didn’t exist previously such as biologic nerve allografts and utilize newer techniques such as targeted re-innervation to give amputees relief of pain as well as the potential for use of functional myoelectric prostheses.  In short, peripheral nerve surgery is an exciting and burgeoning field within the larger realm of plastic surgery which will hopefully continue to grow and develop. While other surgeons may be able to perform such procedures, plastic surgeons have been and continue to be some of the pioneers in the field for the reasons noted above.

For more information on how we can help with your nerve related issues, please call us at (415) 751-0583 in San Francisco and (925) 933-5700 to set up an appointment, and visit www.peledmigrainesurgery.com today to read more about us!

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When Migraines Strike In San Francisco, Can Outpatient Surgery Help?

My name is Dr Ziv Peled. Welcome to the blog for my practice, Peled Migraine Surgery. I live in San Francisco, CA and work as an Plastic Surgeon at Peled Migraine Surgery. Contact the author at This email address is being protected from spambots. You need JavaScript enabled to view it.

When migraines strike, the first thought in many San Francisco residents' minds is "ouch".  After that, they think "medication".  But is medication really the answer to severe headache pain?  While some medication can help alleviate the pain of a migraine in some patients, sometimes they don’t work, they often require chronic use, and sometimes they only work for a short time and then stop working altogether.  When conservative modalities have failed, as they do for many, there is another option.  Peripheral nerve surgery has been clinically proven, when performed by a board-certified plastic surgeon with experience in such procedures, to reduce pain and change people's lives, potentially permanently.  

Axon -mediumLiving with chronic, severe headache pain can be a nightmare, and peripheral nerve surgery can help.  But what is a "peripheral nerve"?  A peripheral nerve simply refers to a nerve outside of the brain and spinal cord.  These nerves, and the surrounding tissue, can become inflamed, causing intense pain.  Such pain is not that different from the pain experienced by someone who steps on a tack with their big toe.  The nerves in the toe become activated and send pain signals back to the brain. If a peripheral nerve in the head/neck is activated because of compression or inflammation those same pain signals may develop and can be a source of migraines.  When it is determined that this is the issue, the problem can be alleviated with a surgical procedure that decompresses the nerve in the hopes of reducing those signals. Recent research has demonstrated that just like at the wrist, there are nerves within the head and neck that are compressed and that decompressing them, can produce significant or even complete relief that can be permanent.

I have been performing peripheral nerve surgery all over the body in San Francisco for a number of years.   My practice now includes many former chronic headache patients who suffered from nerve compression very similar to that which I had been treating for years in the trunk, arms and legs.  I have operated on several hundred nerves in the head/neck and my very positive results with these patients has validated my choice to help people stricken with migraines and other forms of chronic headaches.  I firmly believe that peripheral nerve surgery can help people living with this condition live a more normal life, with significantly reduced or possibly no headache pain.  The gratitude expressed by these patients is the reason that I became a physician in the first place, and I hope that every physician feels the same way I do every day when I come into the office.

For more information about peripheral nerve surgery, and migraine surgery in San Francisco, CA, visit www.peledmigrainesurgery.com today, and call 415-751-0583 to schedule an appointment.

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Whiplash and Occipital Neuralgia: What’s The CONNECTION?

My name is Dr Ziv Peled. Welcome to the blog for my practice, Peled Migraine Surgery. I live in San Francisco, CA and work as an Plastic Surgeon at Peled Migraine Surgery.
I have been asked recently 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 a backward/forward direction or sometimes side to side.  Common causes of whiplash include motor vehicle accidents, sports related injuries and any other violent motions such a shaking a baby too hard or even a big roller coaster ride.  Motor vehicle accidents are by far the most common cause with an estimated incidence of over 1,000,000/year although the true number is hard to gauge since many cases of whiplash are not reported. In 2008, the total estimated cost to the healthcare system of whiplash injury was over 40 billion dollars!

 

headache - mediumOne of the most common sequelae (consequences) of whiplash is chronic neck pain/headaches. Why do these symptoms occur?  Likely, because the nuchal muscles will suddenly tighten as the head is rocked violently and the soft structures that pass through and around these muscles are affected. Nerves are like wet noodles - they are soft and pliable, but the neck muscles and fascia that covers these muscles is tough and tight to begin with to allow stabilization and efficient mobilization of those bowling balls we call our heads. If you think about the force it would take to tear a wet noodle, you get a sense for how easy it could be to injure an occipital nerve.

However, as many out there can attest the work up of these patients is often negative.  Why is that?  The answer lies in what I believe to be the underlying cause of this chronic pain/headache which is a traction (i.e. stretch) injury to the occipital nerves.  Even with high resolution MRIs (see previous post on why the MRI may be negative), the relatively small occipital nerves (greater, lesser and third) are hard to image accurately.  Therefore, a negative MRI may rule out an injury to the nuchal ligaments, bones, and/or muscles, but it cannot rule out a small tear to already tiny nerve(s).  Moreover, since the above-mentioned occipital nerves are purely sensory (i.e. they don’t move any muscles, only provide sensation to the scalp and back of the ears), the primary symptoms tend to be pain which cannot be objectively measured with a CT scan/MRI or blood test.  Since many practitioners don’t recognize the impact of a traction injury to these sensory nerves, management is often empirical.

For these reasons and others, patients are often treated with a combination of pharmacologic agents, PT, chiropractic manipulation, cervical collars, etc.  Certainly many patients do get better with these conservative modalities, but given the sheer numbers we are talking about, many thousands do not.  However, if you believe as I do that the issue may be a tear within a small nerve causing intra-neural scarring, or a small tear within a muscle surrounding that nerve that causes subsequent scarring and narrowing of the canals through which these nerves usually pass (hence compression), then the above-mentioned modalities will not work for obvious reasons.  If there is mechanical compression on a nerve, that compression must be physically and precisely removed or permanent damage may occur.  The take home message is that when all other potential causes of chronic neck pain/headaches post-whiplash have been ruled out, think of occipital neuralgia as a possible cause.  A consultation with an experienced peripheral nerve surgeon should then follow and ON ruled out as a possible cause.  The good news is that if ON is felt to be the culprit, there are safe and effective procedures that can provide significant relief.

For more straight talk about how surgery can help you, contact Peled Migraine Surgery at 415-751-0583 and visit www.peledmigrainesurgery.com today.  Reach the author at This email address is being protected from spambots. You need JavaScript enabled to view it.

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What To Look For When Choosing A Migraine Surgeon

What To Look For When Choosing A Migraine Surgeon

Dr. Ziv Peled explains how to choose a peripheral nerve surgeon, what qualifications to look for and how to decide who is the best fit for you!

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Migraine Solutions Discussed in USA Today

Dr. Ziv Peled, Peripheral Nerve and Plastic Surgeon, was recently asked to sit down and answer some questions about migraines and migraine relief.  Here is a transcript of the interview.

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Dr. Peled Named To Young Plastic Surgeons Steering Committee

Dr. Peled Named To Young Plastic Surgeons Steering Committee

Another exciting honor for Dr. Ziv Peled!

Dr. Ziv Peled was recently asked to serve on the Young Plastic Surgeons (YPS) Steering Committee of the American Society of Plastic Surgeons (ASPS). This Committee is comprised of several up and coming thought leaders in the field of Plastic Surgery and is in charge bringing information on the ASPS/PSF (Plastic Surgery Foundation) to residents and young plastic surgeons and to encourage their professional development through membership in the ASPS. Members also act as liaisons between plastic surgeons in the early stages of their careers and established ASPS Member Surgeons.
The YPS Steering Committee works proactively to convey information about ASPS/PSEF to residents and young plastic surgeons and encourage their professional development through membership in ASPS. Participation on this subcommittee is an opportunity for young members to become actively involved in the Society and Educational Foundation; the committee also promotes a YPS auditor program that invites young plastic surgeons to audit committees of interest.
The YPS Steering Committee also develops the programming for the Annual Meeting's Residents Day and provides input to the Practice Management Education Committee on programming for the annual Senior Residents Conference. In addition, the committee has responsibility for the Breakfast of Champions event and the Fresh Faces panel presentation during the annual meeting.

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The Road To Recovery From Migraine Pain

How long does recovery take following nerve decompression surgery for chronic headaches? The answer to that question can be quite variable and depends on a number of parameters, but a few general principles apply.

How long does recovery take following nerve decompression surgery for chronic headaches? The answer to that question can be quite variable and depends on a number of parameters, but a few general principles apply. First and foremost, each patient is different in terms of their tolerance for discomfort. What may be a 9 out of 10 pain to one person may only be a 5 out of 10 pain to another person. Secondly, the number/distribution of the nerves which are decompressed is also unique to each individual. Obviously, if someone has 8 nerves decompressed in one procedure they are likely to have more discomfort than someone who only had one nerve decompressed. Finally, surgical technique and appropriate post-operative care are also important in achieving optimal results with minimal discomfort and downtime.

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But the Botox Didn't Work On My Migraines! What Now?

But the Botox Didn't Work On My Migraines!  What Now?

One of the questions that I‘m frequently asked during consultations with patients regarding their chronic headaches is, "If I’ve had Botox injections done with other doctors in the past and they have failed, does this mean that Botox injections done with you would not work either?" This is an excellent question and the simple answer is, “No".

One of the questions that I‘m frequently asked during consultations with patients regarding their chronic headaches is, "If I’ve had Botox injections with other doctors in the past and they have failed, does this mean that Botox injections done with Dr. Peled would not work either?" This is an excellent question and the simple answer is, “No".

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How Can You Define Peripheral Nerve Surgery?

How does peripheral nerve surgery help my life, and what can it mean for my migraines?

What exactly is meant by the term, ‘peripheral nerve surgery’? Peripheral nerve surgery specifically refers to operations performed on nerves within the peripheral nervous system, in other words those nerves located outside of the brain and spinal cord (aka the central nervous system). It also helps to think of these nerves as being located in the periphery of the body such as the arms and legs although it also includes nerves located in trunk and scalp/face regions. Pathology causing problems within the peripheral nervous system can take many forms. There can be pressure on a nerve as it passes through its normal route from the brain and spinal cord to its final location, for example at the toes or back of the scalp. There may be pressure on a nerve from a tumor within the nerve itself or from a tumor external to the nerve. A nerve may have been cut from a prior accident or prior surgical procedure. There can also be injuries to nerves that have been excessively stretched such as may occur following a whiplash-type of injury.

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How Can Peripheral Nerve Surgery Help My Migraines?

What do migraine headaches and peripheral nerve surgery have to do with each other?

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Ask me, ask me, ask me!

A recently published study in Health Affairs demonstrated that many patients still have significant reservations about asking their doctors questions regarding their health care.

A recently published study in Health Affairs demonstrated that many patients still have significant reservations about asking their doctors questions regarding their health care (). Many of the patients in the study stated that they feared upsetting their physicians and were scared that doing so would negatively impact their care. Moreover, many patients also apparently felt as though their physicians did not listen to or respect what they had to say. These findings are especially poignant in light of the fact that many of the patients surveyed in his study had a very high education level and an annual income greater than or equal to $100,000 per year.

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Decompression, neurolysis and ablation

Several people have had questions about what ‘neurolysis’ actually means and how it might differ from the term ‘ablation’.

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Let's go to the numbers, shall we....

I just finished reading Dr. Guyuron's article on the finances associated with migraines in its entirety.  The numbers are truly staggering.  Did you know that:

1. Medical resource use for the treatment of migraine headaches is significant, with the fourth most common emergency room complaint being headaches.
2.Patients with migraine headaches generate nearly twice as many medical claims and nearly two and a half times as many pharmacy claims when compared with patients without migraine headaches.
3. Researchers have estimated the annual direct costs of migraine treatment to be as high as $7089 per patient and the annual indirect costs to be as high as $4453 per patient.
4. AFTER TAKING INTO ACCOUNT THE COST OF SURGERY (surgeon, anesthesia, facitlity fees) - the 5-year cost savings were over $11,000 per patient.
5. IN ADDITION, over 5 years, patients can expect to have 43.5 fewer doctor visits, 25 fewer alternative treatment sessions, and 40.25 fewer days missed from work!
6. OVER AND ABOVE ALL THAT, patients reported significant improvements in their overall quality of life on just about every parameter measured!

I guess none of this should be surprising, but it is rare to see numbers like this in the medical literature.  This type of treatment is truly a paradigm shift.

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A Pain in the Neck!

Over the past few months I have seen quite a number of patients who’ve told me that they believe their migraines began not long after a motor vehicle accident. Many of them said they were initially told they suffered from “whiplash” by their treating physicians. These patients tried and subsequently failed several treatment modalities such as physical therapy and muscle relaxant medications.

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The Long & Winding Road

One of the most common refrains I hear from patients is that they are flummoxed by the lack of understanding from their neurologists or neurosurgeons

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friday 9:00 am - 5:00 pm

SAN FRANCISCO

  • 2100 Webster Street, Suite 109, San Francisco, CA 94115
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  • 415-751-0583
  • 415-751-6814

WALNUT CREEK

  • 100 N Wiget Ln #160, Walnut Creek, CA 94598
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  • 925-933-5700
  • 415-751-6814

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