Chronic Headaches


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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 not only dozens of medications used to treat migraines, but dozens of
classes of medications such as triptans, anti-depressants, muscle relaxants, blood pressure medications, narcotics, anesthetics, ergotamines, and so on. Fortunately, a different perspective on chronic headaches has produced remarkable results that have been previously unheard of.

This different school of thought suggests that peripheral nerve irritation (i.e. irritation of nerves outside of the brain and spinal cord such as those within the scalp or forehead) can cause irritation within the central nervous system thus leading to the perception of and symptoms of a headache. If this mechanism were in fact the culprit, then identifying and correcting the cause of such irritation could produce relief from the headache symptoms. Plastic surgeons have been doing exactly that with a common nerve irritation problem known as carpal tunnel syndrome. In this syndrome, a nerve within the wrist is compressed (i.e. pinched) and surgeons decompress (i.e. un-pinch) it thereby relieving the symptoms of pain with a greater than 90% success rate. 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 is permanent.


How Do I Know If A Pinched Nerve Is The Cause of My Headaches?

During your consultation with Dr. Peled, he will take a thorough history focusing specifically on your headache symptoms. We will discuss all the prior treatments which you have tried in the past and go over any old imaging studies. Dr. Peled will then perform a comprehensive physical examination to elucidate if there are any physical findings that suggest that a pinched nerve in the head or neck could be causing your headache. Further imaging studies (i.e. MRIs or CT scans) may be required and if so, they will be ordered accordingly. A series of simple injections with Botox will then be performed in the office. Depending on the results with these various steps, a decision will be made as to whether your headaches could be caused by a pinched nerve and hence your suitability for surgical decompression.




Why use Botox?

Although it might seem a bit odd, Botox is very useful in the work-up to determine whether surgery will be successful. Many of the nerves which can cause headaches are compressed by muscles. Since Botox works by relaxing muscles, it may produce results similar to what may be experienced with surgery. However, these injections must be performed in a very specific way, by someone with a thorough understanding of the anatomy which is being addressed. As a plastic surgeon, Dr. Peled had injected Botox hundreds of times for cosmetic reasons. As a peripheral nerve surgeon, he has similarly injected Botox numerous times, often successfully as a prelude to surgical decompression. Furthermore, as a peripheral nerve surgeon, he has an intimate understanding of the anatomy of the peripheral nerves within the head and neck.




If I’m a Candidate for This Type of Surgery, How Is It Performed?

Surgical decompression for chronic headaches is performed as an outpatient procedure at an accredited surgery center or in the outpatient department of the California Pacific Medical Center. The procedures can last anywhere from 1 hour to 3 hours depending on the number and locations of the nerves being treated. There are few restrictions following the procedure and discomfort is usually very well tolerated with oral pain medication. For more specific information, please contact us for a formal consultation.





What Are the Results With This Type of Surgery?

The results with these types of procedures have been quite dramatic. In one study out of Georgetown University, data from 190 patients with pain/headaches in the back of the head who underwent surgical decompression were analyzed. Over 80% of patients experienced at least 50% pain relief and over 43% of patients experienced complete relief of their headaches! In February 2011, the five-year results of such procedures were published in the medical journal, Plastic and Reconstructive Surgery. These results demonstrated five years following their operation, 88% of patients still reported greater than 50% improvement in their headache symptoms and 29% were completely headache-free!

To find out more about these exciting developments, please call us to schedule a formal consultation.




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