Peled Migraine Surgery Blog

Information and knowledge about migraine relief surgery.

Oct
02

Peled Migraine Surgery Helps Eliminate Walnut Creek Migraines!

Migraine headaches have traditionally been thought to begin within the central nervous system (i.e. the brain and/or spinal cord) and then produce symptoms elsewhere such as throbbing in the back of the head, forehead or temples. There are many theories as to what exactly within the central nervous system is causing these chronic and often debilitating headaches. Some of these theories include pathologic blood vessel dilatation and constriction (loosening and tightening), abnormal firing of neurons within the brain, and abnormalities of various biologic substances (e.g. serotonin, calcitonin gene-related peptide). The fact that no one theory has been proven correct is likely one of the many reasons that there are so many different methods for the treatment of chronic headaches like migraines. In fact, from a medication standpoint alone, there are dozens of medications and medication classes used to treat migraines.

Continue reading
Oct
04

Restoring Anatomy and Nerve Regeneration

As awareness of “migraine surgery” increases, I have often been confronted by the question of whether the nerves that are involved need to be cut for the procedure to be effective. The answer to this question is “sometimes”, but let me elaborate in the next few sentences. There generally seems to be two perspectives on how to deal with "smaller" sensory nerves, in other words those with relatively small areas of sensory distribution. One approach would postulate that cutting the nerve oftentimes leaves a small area of numbness which is easily tolerated or is not even appreciated by the patient and therefore is a relatively good trade-off for relief of pain. Another perspective is that if the nerve is viable as noted during surgery, then leaving it intact will hopefully allow good relief of pain and preservation of sensation. Each of these approaches has its advantages and its disadvantages. Cutting the nerve can lead to immediate relief, but often leaves a noticeable area of numbness. Leaving the nerve intact requires the nerve to heal, recover and/or regenerate from the compression/irritation which was present as the cause for the surgical procedure. This process often requires several months depending on the longevity and severity of the compression/irritation, but if successful should lead to decreased pain and a preservation of some degree of sensitivity. Both procedures carry a small risk that nerve recovery will not occur and pain may persist. In the case of a cut nerve, the proximal (upstream) nerve end may remain persistently sensitive thus leading to a "phantom limb" type of sensation despite numbness in the former area of distribution. In the case of a decompressed nerve, the nerve may not regenerate again leading to persistent discomfort. Moreover, both procedures carry a small risk of neuroma formation although I personally believe that this risk is slightly less when nerves are left intact as compared to when they are cut.

Continue reading
Oct
25

What If I Still Have Headaches?

What If I Still Have Headaches?

Over the years, as I have operated on more and more patients with chronic headaches, my impression of this problem has changed somewhat. Time and again, I would see patients who had severe, frequent, long-lasting headaches who underwent surgery with me and did extremely well. Their headache frequency, severity and duration decreased significantly after their procedure and they were extremely happy.  However, many patients still experienced severe headaches from time to time and the question that was posed to be on many occasions was, "What does it mean that I still have some severe headaches after surgery?" As I have talked with numerous such patients on many occasions and drilled down on their remaining symptoms and their treatment of these symptoms, an interesting observation occurred to me.

Continue reading
Nov
14

HOW MANY HEADACHES IS TOO MANY?

HOW MANY HEADACHES IS TOO MANY?

Over the past year or so, I’ve noticed that many patients are being told by their other treating “headache doctors” that they shouldn’t consider surgery for their problem because their headaches are “not bad enough”.   Patients are often so struck by these remarks that many wonder whether this statement represents actual medical fact and repeat it to me as if it were empirically true. They then ask me if I agree with that concept.  My answer is always the same, “The only person who can say whether the pain you’re having is too much, is YOU.”

Continue reading
Nov
25

BLOCKS & STIMULATORS & DECOMPRESSION, OH MY?!?

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 will be variations in how each clinician may use these modalities, if only because each patient presents a unique clinical dilemma.  While I certainly can't speak to the ways in which others utilize these modalities, I can offer general guidelines as to how I use them in my practice.  Hopefully this information will also provide some insight into the advantages and disadvantages of each.

Continue reading
Dec
09

Medication Overuse Headache (MOH) or ‘Rebound Headaches”

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.  The precise medical term for this disorder is Medication Overuse Headache (MOH) or analgesic rebound headache.  The prevalence of this problem is about 1% in the general population and as with many types of headaches, is higher in women than in men.  The underlying mechanisms for MOH are unknown, but as with many medical problems, are oftentimes multifactorial.  It is known that there can be a genetic predisposition to MOH.   In addition, long-term exposure to opiates is known to cause changes in the nervous system through increased expression of specific cytokines (chemicals, e.g. Calcitonin Gene-Related Peptide) and increased activity of certain neural pathways felt to modulate the sensation of pain.  Some people also feel that addictive personality disorders are associated with MOH. Interestingly, migraines are the thought to be the most common “primary headache disorder” that has been linked to MOH. The bad news is that just about any medication used to treat chronic headaches has the potential to lead to MOH.

Continue reading
Dec
19

Neuroma 101

Neuroma 101

First of all, what is a neuroma? A neuroma can be defined in one of two ways. One, as a tumor composed of nerve tissue such as an acoustic neuroma. Almost overwhelmingly, these tumors are benign. The more common usage of the term neuroma means a mass of nerve tissue consisting of regenerating nerve fibers that have been previously severed or injured somehow. When a nerve is injured, it tries to re-grow - that’s what nerves do. If that nerve re-grows into the scar at the skin, it can cause exquisite pain even with light touch in the area. This situation would be akin to having a cavity (which hurts because the nerve at the root of the tooth is exposed) and eating ice cream - ouch! So if a nerve is severed or injured in some other way, how do you prevent a neuroma from occurring?

Continue reading
Jan
02

WHY DOES IT HURT SO MUCH AFTER THE INJECTION?!?

WHY DOES IT HURT SO MUCH AFTER THE INJECTION?!?

I’ve heard from so many people over the years who consistently tell me that they had worse pain AFTER their injections - whether it is Botox, a local anesthetic (such as is used in nerve blocks) and/or steroids. Remarkably, despite numerous queries to their treating clinicians, their physicians have never had a good answer for them as to why this problem happens. Actually, the answers are quite simple. Worse pain after injections such as those done to diagnose ON can occur for several reasons.

One reason is that the injections done for ON are performed within muscle. Injections into muscle cause a little muscle inflammation/swelling no matter what you inject (even saline) and this inflammation causes discomfort. Anyone who has ever had a tetanus shot into the shoulder muscle (deltoid) knows exactly what I’m talking about. Their shoulder can be sore for 7-10 days afterwards. Fortunately, the discomfort is temporary and only lasts a few hours or days as the inflammation/swelling subsides.

Continue reading

WORKING HOURS

Monday 9:00 am - 5:00 pm
tuesday 9:00 am - 5:00 pm
wednesday 9:00 am - 5.00 pm
thursday 9:00 am - 5:00 pm
friday 9:00 am - 5:00 pm

SAN FRANCISCO

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

WALNUT CREEK

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

This email address is being protected from spambots. You need JavaScript enabled to view it.