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The concept that peripheral nerves in the head and neck could be responsible for chronic headaches in selected patients originated with Dr. Bahman Guyuron in Cleveland, Ohio. Dr. Guyuron was chairman of the Department of Plastic Surgery at Case Western Reserve University and a well-respected, aesthetic plastic surgeon. He noted that in a sub-population of his cosmetic browlift patients, the removal of the small muscles in between the eyebrows not only gave them a youthful look, but also improved or in some cases eliminated their migraine headaches. As he saw more and more such results, he began to realize that they were no fluke. Eventually, after studying these patients very carefully he learned that what he was really doing was un-pinching small nerves in these areas thereby removing a source of nerve irritation that was causing the headache symptoms. Relief


What Nerves Can Cause Headaches & Where Are They Located?


The nerves causing your headaches are typically located in one of four different locations within the head and neck region. The first site is between the eyebrows, also known as the glabella. The nerves that can become compressed in this area are known as the supraorbital and supratrochlear nerves. These nerves can become pinched by the muscles within this region that cause the frown lines with which many of us are familiar. The next site is the temple region and the nerves which can be compressed in this area are called the zygomaticotemporal nerves and auriculotemporal nerves. These nerves can become compressed by one of the muscles used for chewing (the temporalis muscle) or by an blood vessels which can place excessive pressure on these two nerves or thier branches. A third area that can be a trigger zone for chronic headaches is the back of the head and the nerves in this area which can be the cause of trouble are known as the greater, lesser and third (or least) occipital nerves. These nerves can be compressed (i.e. pinched) by the strong neck muscles which can be in spasm, by the tight connective tissue that surrounds them or by blood vessels which can wrap themselves around these nerves as well. Finally, nerves within the inner lining of the nose can also become irritated and result in chronic headaches such as migraines.

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If You Identify the Problem Nerves, How Do You Fix Them?


Once the nerve or nerves causing the problem have been correctly identified, an outpatient surgical procedure can be performed to remove the mechanical compression causing the nerve irritation. This procedure is performed by making an incision through the skin, identifying the offending nerves, safely protecting them and removing any of the mechanically compressive tissues. In some situations, if the nerves are too damaged, they are actually transected, but in most cases, only in areas where very little loss of sensation would occur. In many of these cases, patients often never know that a nerve has actually been excised.

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What Are the Published Results?


At this point there are over 40 peer-reviewed publications from the US, Europe and Asia that demonstrate successful results with headache surgery. One study from Georgetown University followed 190 patients who had migraines secondary to occipital neuralgia (i.e. peripheral nerve compression) and who underwent surgical treatment. At an average follow-up of one year, 80.5% of patients experienced 50% or greater pain relief and over 40% of the patients experienced complete relief of their headaches (Ducic, et al, Plastic and Reconstructive Surgery, May, 2009, 1453-1461). In addition, another study published just last year demonstrated that at 5 years post-surgery, these benefits persist with continued reductions in headache severity, frequency, and/or duration (Guyuron, et al, Plastic and Reconstructive Surgery, February, 2011, 603-608). Dr. Peled’s results are comparable to these results and as you can see by going to the ‘Testimonials’ page, a numbr of his patients are now headache-free. He has published several papers that continue to refine our understanding of the anatomy of the nerves being treated and has even pioneered a novel approach to one of these nerves (Peled, et al, Plastic and Reconstructive Surgery - Global Open, March, 2016, e639; Peled, ZM, Plastic and Reconstructive Surgery, May, 2016, 1597-1600.)  It is estimated that migraines afflict over 36 million people in the United States alone. The annual cost to the healthcare system in terms of ER visits, medications, injections and lost productivity is estimated to be in the range of $15 billion per annum. Fortunately, the surgical treatment noted above continues to demonstrate extremely promising results.

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