Peled Migraine Surgery Blog

Information and knowledge about migraine relief surgery.

Fears and Misconceptions About Headache/Migraine Surgery - Part 1

Fears and Misconceptions About HeadacheMigraine Surgery Part 1

Many patients have told me about their fear and anxiety regarding an upcoming surgical procedure.  Having undergone several operations as a patient myself, I can empathize with these emotions and often tell patients that it is completely normal to feel this way before going “under the knife”.  I also try to re-assure them and their loved ones that they will be taken care of as best as possible before, during and after their procedure.  However, it struck me that there are often many misconceptions about headache/migraine surgery that heighten this anxiety so I though I would address them in a few blog posts.  It would be impossible to discuss every possible misconception I’ve heard, but hopefully some of these explanations will help.

  • Misconception 1 - These operations are like brain or spinal surgery. This is a common misconception because we are operating on nerves in the head and neck region.  However, there are numerous nerves in those areas of the body that are not within the skull or spinal column.  Because these nerves are located outside of the central nervous system (i.e. the brain and spinal cord) they fall under the field of peripheral nerve surgery, much like carpal tunnel release.  In fact, most patients have had numerous imaging studies of their brain and spinal cord which have revealed nothing in those areas that their initial treating physicians think would account for their symptoms.  And much like carpal tunnel syndrome, many of these nerves can be compressed at certain anatomic points which fortunately, can be released during a set of outpatient surgical procedures that are safe and very effective.
  • Misconception 2 – Cutting a piece of muscle in my face or neck will leave me paralyzed. I have heard this misconception many times and it is simply untrue.   The amount of muscle we remove when we perform a decompression of say the greater occipital nerve is about the size of a thumbnail in a muscle almost as big as the bicep.  Therefore, it is akin to performing a muscle biopsy, a commonly performed operation.  If you think about it, the target nerves in a headache operation are quite small (which is why they are often unable to be imaged well even with MRI) and therefore the space we need to make for them doesn’t have to be enormous.  I have yet to have a patient return to the office with any decreased muscle function.  While complications such as paralysis can occur with any operation on a nerve, proper technique and a thorough knowledge of anatomy makes this possibility quite rare. It is therefore important, for this and many other reasons, to seek out an experienced peripheral nerve surgeon for your headache/migraine operation (see blog post on “How To Choose A Headache Surgeon”)
  • Misconception 3 – Cutting any nerve will always lead to more pain. If I only had a dollar for every time I’ve heard this sentence.  It is often something that patients will hear from their non-surgical physicians and is simply untrue.  In fact, one of the most common surgical procedures performed is cutting of a nerve between the toes for a condition known as “Morton’s Neuroma”.  If this misconception were true, these operations would no longer exist.  It is also a commonly accepted peripheral nerve surgical dictum, that a neuroma must be removed and the nerve either reconstructed or the nerve end buried in the local muscle.  With these maneuvers, a painful neuroma is very unlikely to form.  While there is always the risk of increased pain when operating on any sensory nerve (even the one in carpal tunnel releases), with proper technique and a thorough knowledge of anatomy the likelihood of this issue is very low.

Hope these explanations help to some degree.  In a future blog post, I plan to address other misconceptions that seem to strike fear in the hearts of those considering an operation for relief of their chronic headache pain.  To learn more about Migraine Surgery, visit www.peledmigrainesurgery.com today or call 415-751-0583 to make an appointment.

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What is Peripheral Nerve Surgery For Migraines?

2018 06 15 1602

Dr. Peled explains what the term "Peripheral Nerve Surgery" means, and how it pertains to Migraine Surgery and Headache Surgery. 

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Determining Candidates For Migraine Surgery

Dr. Peled discusses the steps that Peled Plastic Surgery follows to determine if a patient is a candidate for headache surgery or migraine surgery.  The video above will help you determine if you may be a candidate, and then you can follow up with a call to Peled Migraine Surgery at 415-751-0583 or by visiting www.peledmigrainesurgery.com to learn more about this life-changing surgery.  Don't live with migraines if you don't have to.

2018 06 15 1602

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A Different Way to Think About Chronic Headaches

A Different Way to Think About Chronic Headaches

Chronic headaches represent an enormous medical problem both worldwide and in the US.  Migraines alone represent the most common primary headache disorder for which people seek treatment. It is estimated that over 36 million people suffer from migraines in America1, representing about 11.5% of the population or more than one in 10 people. Chronic migraines are thought to affect 2% of the population or over 7 million people in the US2.  If you factor in both direct and indirect (e.g. days of bedrest) costs to the healthcare system, you are looking at between $10-$30 billion dollars in annual expenditure3,4.  Moreover and specific to migraines, it has been shown that the health-related quality of life of people suffering from this type of debilitating headache approximates that of patients suffering from congestive heart failure, high blood pressure or diabetes5.  Interestingly migraines are primarily defined and diagnoses made by their clinical characteristics.  In other words, headache patients are usually diagnosed as suffering from migraines if they have recurrent attacks, a pro-drome (e.g. warning signal), an aura, a headache and a post-drome (e.g. after effects).  While many patients can relate to these symptoms, not every patient is the same. Specifically, while other types of headaches have slightly different characteristics, there are similarities in symptoms with migraines and sometimes, patients can have symptoms characteristic of more than one type of headache.  In those cases, how should we diagnose the patient? 

In my view, a different way to think about headaches and perhaps to classify them is by what the underlying etiology (i.e. cause) is thought to be.  I am a firm believer in doing the most conservative thing possible that would give you the best result and along those lines, an evaluation by a neurologist and/or headache specialist with a careful work up is a critical first step.  Appropriate imaging (e.g. MRI of the brain, cervical spine, etc.) as necessary and trials of medications are often the first lines of evaluation and treatment, usually with non-operative interventions as adjunctive measures.  Examples of such adjunctive modalities are physical therapy, therapeutic massage, acupuncture, biofeedback, etc.  However, as we note above, there are so many people that suffer from debilitating, chronic headaches that even if only 10% of people fail such measures (the number is likely much higher), then we have millions of people who continue to suffer greatly.  In these instances, we often have to “think outside the box”.  There continues to be a growing body of literature which suggests that some people suffer headaches as a result of peripheral nerve compression in the head and neck region and who find relief from nerve decompression or even neurectomy (i.e. transection of the nerve) with muscle implantation. 

Given that many people who fail traditional treatment as outlined above have been given the diagnosis of migraines (or migraine variants), perhaps it is our diagnoses that are incorrect.  Many of those same people are successfully treated with surgical decompression. Perhaps, many people who have been diagnosed with “migraines” actually have neuralgia.  This word comes from a combination of neur - meaning nerve and algia - meaning pain and hence the word itself literally means nerve pain.  The question is which nerve is causing the pain and what can you do about it?  Fortunately, there are good answers to these questions, but the diagnosis of neuralgia must be on the radar screen of the evaluating physician.  Hence, if traditional modalities have been unsuccessful or only partially successful, don’t lose hope!

  1. Lipton, R. B., Bigal, M. E., Diamond, M., et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007;68:343-349.
  2. Schwedt TJ, Chromic Migraine. BMJ 2014; 348: 1416-1427.
  3. Goldberg, L. D. The cost of migraine and its treatment. The American Journal of Managed Care 2005;11:S62-67.
  4. Hu, X. H., Markson, L. E., Lipton, R. B., Stewart, W. F., Berger, M. L. Burden of migraine in the United States: disability and economic costs. Archives of Internal Medicine 1999;159:813-818.
  5. Turner-Bowker, D. M., Bayliss, M. S., Ware, J. E., Jr., Kosinski, M. Usefulness of the SF-8 Health Survey for comparing the impact of migraine and other conditions. Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation 2003;12:1003-1012.
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Recent Comments
Ziv
Dear Kathy, I don't do pulsed RFA so I don't have a specific comment on how it works, but my understanding is the same as yours i... Read More
Thursday, 12 April 2018 10:26
Ziv
I do think that, in general, many conservative modalities, so long as they don't injure the nerves further with too aggressive an ... Read More
Friday, 13 April 2018 10:39
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