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An Olympic Crash and Migraines

An Olympic Crash and Migraines

If you’ve been paying attention to the Winter Olympics in South Korea, you might have seen American luger Emily Sweeney crash on her fourth and final run at approximately 68 miles per hour.  It was clear that she was initially stunned, but happily was able to get up and walk away on her own.  Sometime later, she was being interviewed by a reporter from NBC and stated that she was ok adding that she was also very sore and stiff and was about to get an x-ray of her back.  Obviously, we all hope that Ms. Sweeney has no significant, permanent injuries and we all respect her courage and toughness in competing at a difficult sport at such a high level, especially when faced with the prospect of injury.  However, in watching her interview, I couldn’t help, but feel that there was some continued suffering in her affect and voice.

If you watch her actual crash, you can’t help but notice the impact of the speed and ice on her body as you see her hit her head and the contortions that follow.  Sadly, I see people who have had similar injuries from motor vehicle accidents, falls from horses and other types of sports who suffer from chronic headaches.  Many of these people have been diagnosed with “whiplash” which tends to be a basket diagnosis when someone has continued chronic pain, usually headaches, but whose workup including x-rays and MRIs don’t show any pathology and whose etiology remains unclear.  Unfortunately, at this point in time x-rays and MRIs (even magnetic resonance neurograms) are often not sensitive enough to pick up injuries in very tiny nerves that can cause significant pain.  In the case of neck injuries following which people experience chronic headaches, I believe that many of these symptoms are caused by traction (i.e. stretch) injuries of the various occipital nerves resulting in scar impingement around the nerves or actual tears within the nerves themselves.  These tears then heal with scar impacting nerve conduction and resulting in numbness, tingling and/or pain.  As a result, these patients end up seeing many different types of doctors who often prescribe many different types of drugs and give many types of injections in the hopes of treating this pain permanently. 

However, whenever there is a mechanical injury of a nerve, for example, compression secondary to scar tissue formation, a mechanical solution needs to be found.  For these patients, a simple nerve block (i.e. injection of local anesthetic) used in a diagnostic manner, will not only provide temporary relief, but allow the experienced peripheral nerve surgeon to discern which nerve or nerves may be involved in that particular person’s symptoms thereby pointing the way to a potential surgical solution which is often permanent.  Sadly, peripheral nerve pathology as a cause for many cases of whiplash or sports concussions with resulting headaches remains very unrecognized.  However, some physicians including some prominent neurologists are actually coming around to recognizing that structures outside of the brain and spinal cord can cause debilitating headaches.  Happily, they refer these patients to a trained peripheral nerve surgeon for appropriate diagnostic workup and ultimately treatment.  Hopefully Ms. Sweeney will not require surgical intervention of any kind, but if she were to experience chronic headaches with no other identifiable cause, I would hope that her trainers and doctors consider the possibility that a stretch injury to a peripheral nerve may be the underlying etiology which will save her and perhaps many others years of suffering.

To learn more about how migraine surgery can help with migraines caused by peripheral nerve damage from sports injuries or whiplash, visit www.peledmigrainesurgery.com today or call (415) 751-0583 to make an appointment.  Don't live with migraines if you don't have to. 

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Comments

Guest - Kathy on Monday, 19 February 2018 02:54

Even though you are able to detect the area where the nerve is damaged through diagnostic nerve blocks, I'm not seeing that those areas are treated directly, only indirectly through one incision that is the same for all patients for the GON, LON, and TON. How does one decompress a nerve if it does not correlate with the area of incision? If you can speak to that issue in a follow up blog post, that would be very helpful.

Even though you are able to detect the area where the nerve is damaged through diagnostic nerve blocks, I'm not seeing that those areas are treated directly, only indirectly through one incision that is the same for all patients for the GON, LON, and TON. How does one decompress a nerve if it does not correlate with the area of incision? If you can speak to that issue in a follow up blog post, that would be very helpful.
Dr Ziv Peled on Monday, 19 February 2018 14:51

Kathy. Thank you for your comment. Actually, the GON and TON are both accessed through the same midline incision since they are both paramedian structures. The GON is simply deeper in the initial surgical approach. Both are directly accessed through that midline incision. The LON is accessed through a separate, smaller incision on the lateral neck caudal and posterior to the ear as it is a more lateral structure. Hence I do three incisions total to access all 6 occipital nerves bilaterally.

Kathy. Thank you for your comment. Actually, the GON and TON are both accessed through the same midline incision since they are both paramedian structures. The GON is simply deeper in the initial surgical approach. Both are directly accessed through that midline incision. The LON is accessed through a separate, smaller incision on the lateral neck caudal and posterior to the ear as it is a more lateral structure. Hence I do three incisions total to access all 6 occipital nerves bilaterally.
Dr Ziv Peled on Monday, 19 February 2018 17:58

With regards to the above reply, this first picture demonstrates the larger GON more cephalically and the TON more caudally. The second picture demonstrates a decompressed LON from the lateral incision referenced above.
http://peledmigrainesurgery.com/images/stories/Peled%20Surgery%201.png
http://peledmigrainesurgery.com/images/stories/Peled%20Surgery%202.png

With regards to the above reply, this first picture demonstrates the larger GON more cephalically and the TON more caudally. The second picture demonstrates a decompressed LON from the lateral incision referenced above. http://peledmigrainesurgery.com/images/stories/Peled%20Surgery%201.png http://peledmigrainesurgery.com/images/stories/Peled%20Surgery%202.png
Guest - Kathy Gumbleton on Tuesday, 20 February 2018 15:42

Thank you for your reply! I think I should have rephrased my question. I understand that the incision for the GON, LON and TON are different, but for all patients, the incision is in the same area for the GON, the same area for the LON etc. In the case of nerve excision I can understand that the same incision area for everyone makes sense, however, I'm still a little confused about the case of nerve decompression. Are all areas of the nerve reachable from the same incision point for nerve decompression? For example, if you discovered I had an area along the GON nerve that needed to be decompressed, based on results from diagnostic nerve blocks, and that area was far away from the incision point, could you still reach that area to decompress the nerve? From the images it looks like a 2-3 inch incision. How can you tell whether the nerve is compressed and therefore requires decompression vs. damaged and therefor requires excision if the area lies outside the incision area? Thanks so much Dr. Peled!

Thank you for your reply! I think I should have rephrased my question. I understand that the incision for the GON, LON and TON are different, but for all patients, the incision is in the same area for the GON, the same area for the LON etc. In the case of nerve excision I can understand that the same incision area for everyone makes sense, however, I'm still a little confused about the case of nerve decompression. Are all areas of the nerve reachable from the same incision point for nerve decompression? For example, if you discovered I had an area along the GON nerve that needed to be decompressed, based on results from diagnostic nerve blocks, and that area was far away from the incision point, could you still reach that area to decompress the nerve? From the images it looks like a 2-3 inch incision. How can you tell whether the nerve is compressed and therefore requires decompression vs. damaged and therefor requires excision if the area lies outside the incision area? Thanks so much Dr. Peled!
Ziv on Wednesday, 21 February 2018 17:04

Kathy,
I'm not sure the gist of your last question, but whether you're doing excision or decompression the nerves are accessed through the same incisions. All of the potential compression point of the GON, for example are visible through the midline incision and all are examined in each patient and released if necessary. Not all potential compression points are involved in each patient and if there is no compression at that point, the nerve is left alone there. Hopefully that clears up any issues. Please let me know if it doesn't. Cheers.

Kathy, I'm not sure the gist of your last question, but whether you're doing excision or decompression the nerves are accessed through the same incisions. All of the potential compression point of the GON, for example are visible through the midline incision and all are examined in each patient and released if necessary. Not all potential compression points are involved in each patient and if there is no compression at that point, the nerve is left alone there. Hopefully that clears up any issues. Please let me know if it doesn't. Cheers.
Guest - Kathy on Friday, 23 February 2018 07:37

Thank you, yes, you got the gist of my question! I assume that is the same for the LON and TON too. Thank you so much Dr. Peled! Your answer made me curious about these 6 compression points. Should I assume then that there are only six places ie. compression points, where the nerve can "get trapped" ? Thank you so very much again! I'm assuming the answer is yes?

Thank you, yes, you got the gist of my question! I assume that is the same for the LON and TON too. Thank you so much Dr. Peled! Your answer made me curious about these 6 compression points. Should I assume then that there are only six places ie. compression points, where the nerve can "get trapped" ? Thank you so very much again! I'm assuming the answer is yes?
Ziv on Friday, 23 February 2018 10:16

There are 6 compression points for the GON. Fewer for the others.

There are 6 compression points for the GON. Fewer for the others.
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