Peled Migraine Surgery Blog

Information and knowledge about migraine relief surgery.

Does One Nerve Operation Fit For All Cases?

headache, migraine surgeryThis post will not be a strictly medical one, but I believe is important in terms of general understanding and information, nonetheless. There have been numerous posts by various people asking some version of, “How much does NDS cost?” It is certainly a reasonable question and one that is totally appropriate to ask. However, the presumption in the question is that NDS is one operation which it most certainly is not. It is also quite a loaded question for a number of reasons, the least of which is what is meant by the term ‘cost’. Let expound on this concept a bit further.

There are at least 14 nerves that I can think of (7 on each side of the head) that can be addressed surgically to treat occipital neuralgia and/or (as I like to call it) trigeminal branch neuralgia (TBN). Concomitantly, there are many factors that go into deciding how and what to do with these nerves:
1. How many nerves are affected? 1 or 14; obviously the more nerves you have to treat, the longer the procedure is likely to take. If this is a revision procedure, it is likely to take longer as there is scarring in the operative field that must be accounted for in terms of deciding how long a procedure will take and how long to book for the case.
2. What will you do with those nerves - decompress them or transect them? If the latter, then you also have to figure into the mix burying them in the muscle.
3. What is the patient willing to tolerate in terms of post-operative sensation? In other words, does the patient mind the numbness associated with nerve transection or do they wish to preserve sensation to as great a degree as possible? Alternatively, will they leave that to the judgment of the surgeon at the time of surgery?
4. How many nerve blocks does it take to most accurately diagnose which nerves can/will need to be addressed?
5. What other co-morbidities does the patient have? The surgical procedure will take less time if you’re operating on one nerve in a thin woman with a long, swan neck, than it will on a 350 pound former NFL lineman (yes, a real patient of mine) with numerous nerves that need to be addressed. Also, the more medical problems one has, the more likely your procedure will need to take place in a hospital setting as compared with a surgery center.
6. What about facility fees? The facility will often charge or bill the insurance more for a longer operation than a shorter one as the former likely also involves more CPT codes (see above) than the latter.
7. What about anesthesia fees? Anesthesia groups typically bill by the hour.
8. The last two points are relevant if your insurance company considers these procedures “experimental” and hence are unlikely to authorize or pay for them.
9. What about opportunity costs (i.e. time off of work)? Clearly, the answer to this question will depend on how many nerves are being addressed, (which, in turn affects) how long the procedure takes, your pain tolerance, the nature of your profession, what support you have at home (e.g. family and friends who can help out, whether or not you have children) and your state’s/employer’s policies.
Please keep in mind that the list above is by no means exhaustive. However, the point is that NDS is not like an appendectomy (removal of the appendix). That type of case is virtually the same in everyone. There is always one appendix, it is always in the same place, and it always has to be removed if it is inflamed or ruptured. You can’t decompress it. The first thing to do is to be evaluated by a surgeon with experience in surgically treating ON or TBN and have a frank discussion about these issues. If you feel comfortable with the answers you receive, then perhaps you are in the right place.

If this article or anything in it sounds familiar, please contact us at Peled Migraine Surgery, at 415-751-0583 and visit our site at for more information on how peripheral nerve surgery may relieve your pain.

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