This post was sent to us by a patient that had experienced migraines for years and was seen by Dr. Peled 3 months ago. We are happy to share his story and so pleased with his recovery.
From 2005-2017 I experienced severe migraine headaches characterized by overwhelming pain in the back of my neck, eyes and temples, and severe nausea and vomiting.
From 2014-2017, the frequency and severity of these headaches intensified. They became debilitating. I had to change every aspect of my lifestyle in order to manage them.
When I wasn't having a headache, I was afraid of getting one. No matter how perfect I was with food, posture, exercise, sleep, stress, workload–everything!–I was still waking up with headache pain several times per week.
I had a migraine and was feeling miserable when I snapped this selfie while hiking in Florida in 2014
I was sure that I was on course to being handicapped by these headaches for the rest of my life. I had resigned myself to the fact that being sick was my fate. There are tens of millions of disabled people on this planet. I never imagined I would be one of them.
But there I was, bent over the toilet vomiting day after day, week after week, year after year. I couldn't do the things normal people do because I was in constant fear of awakening in the morning with that feeling that tens of millions of migraineurs know so well–"oh no, I have a headache today."
By late 2017 after an unending streak of failed treatment, I was close to making peace with my illness.
One night in October 2017 I was 18 hours into a migraine. I had woken up with a headache and it worsened throughout the day. It was now midnight and the pain was peaking. I consumed no food and hardly any water all day, but still, the nausea was so severe that I was bent over the toilet vomiting bile for the 4th or 5th time.
I rinsed my mouth, splashed my face with cold water and exited the bathroom into the complete darkness of the hallway. I leaned against the wall into my forearm and was overcome with tears. I sobbed for 15 minutes straight. "This is my life now," I thought. "It's okay. Stop fighting it."
Less than two months later I had migraine surgery with Dr. Ziv Peled and when I emerged from the operating table the headaches were gone.
It was just 4 days after migraine surgery and I was at my first follow-up with Dr. Ziv Peled. My recovery was just beginning but already I was convinced that the procedure was a slam dunk and that I had been fixed.
On my way out of his office, I shook Dr. Peled's hand and said, "Thank you, you gave me a new life."
"Let's not claim victory just yet," he replied.
What he meant is that it is irresponsible to pass judgment on the effectiveness of migraine surgery for at least 3 months following the procedure. This is because surgery is invasive and makes a big mess of things.
Migraine surgery involves cutting and laser-burning scar tissue, muscle and other structures that are compressing the target nerves. Therefore any headache pain felt for several months after surgery might be related to the invasiveness of the surgery itself. It takes a while after the operation for things to settle down.
Well, it's been three months and the dust has settled and I am finally ready to pass judgment on the effectiveness of my December 2nd migraine surgery.
The truth is that I really did know immediately after surgery that the procedure was a home run and that I had been almost completely cured. But I wanted to follow migraine surgery protocol and wait at least 3 months before publicly declaring victory.
Tasting victory the moment I woke up from migraine surgery!
How did I know? From 2013-2016 I spent over 16 months living at two Buddhist monasteries where I received formal meditation training. While living at these monasteries I spent 2-8 hours per day performing seated breath meditation which resulted in me becoming hyperaware of the sensations occurring inside my body.
During this same three year period of monastery-living, my migraine episodes became much worse. There were certain awful stretches at the monastery where every other day I would have 10/10 headache episodes with nausea and vomiting.
As a result, my headache pain became a main focus of my meditation. I would use my breathing to explore the pain and bring myself relief. During this time I came to know the topography of my headache pain like the back of my hand.
On the surface, a migraine headache might seem to be composed of one monolithic blob of pain that descends from thin air onto the head like a black rain cloud.
But with my meditation, I realized that actually there were certain spots in the back of my neck, eyes, and temples that were like little cel-towers that radiated pain outward.
I came to think of these spots as trigger points. Pressing on them with my fingers at any time would create zingy migraine pain that would radiate across my scalp and even into my gut.
There was one trigger point, in particular, that was especially bad. It was on the back of my neck in the vicinity of my right lesser occipital nerve and it almost constantly radiated headache pain.
During surgery, Dr. Peled discovered that the source of this trigger point was my genetically abnormal right lesser occipital nerve which had 3 branches instead of 1 (the normal amount), all of which were severely compressed.
My left lesser occipital nerve was even worse–it had 4 branches, all compressed.
Compressed lesser occipital nerves were the cause of headache trigger points I had felt for years.
Surgery would also reveal that I had severe compression to my greater and third occipital nerves which corresponded to the other trigger points I had felt for years.
The nerve compression seen above corresponds to one of my pre-surgery trigger points.
Compare my decompressed left greater occipital nerve in this photo to the photo above to see how compressed this nerve really was.
I remember the moment I realized that migraine surgery worked. I was in the car on the way home from the procedure, still hazy from the anesthesia but alert enough to do a bit of exploring.
I pressed my finger into my worst trigger point on the right side of the back of my neck: the area was numb and I felt no zing. Totally pain-free. I tried my left side. Same thing–painless. Next, I tried a few other hotspots in the back of my neck and they were all the same: numb and neutral.
I could not remember any time prior to these moments that I had pressed into these spots without invoking headache symptoms. This was a miracle. I knew right then and there that Dr. Peled had eradicated whatever it was in my neck that was transmitting all that pain.
Dr. Peled decompressed my greater, lesser and third occipital nerves. All of these nerves are located in the back of the neck and back of the scalp. Since surgery, I have had almost no headache pain at all in this region and I feel 85% better than before.
This means that all along my occipital nerves accounted for 85% of my migraine pain.
I continue to have relatively mild, relatively infrequent headache pain in my eyes and temples. Whatever headache pain I'm still having–that last 15%–is entirely up front where Dr. Peled did not operate.
In the temple is the zygomaticotemporal nerve, near the side of the eye socket. And in the eyebrow and lower forehead are the supraorbital and supratrochlear nerve. Like the occipital nerves, these three nerves are common migraine-triggering culprits.
The inflammation of these nerves can be a side effect of the inflammation of the occipital nerves. The eye/temple nerves and occipital nerves do not actually touch each other in the scalp. But as they approach the spinal column, they lie beside each other.
So when the occipital nerves become chronically inflamed, the adjacent frontotemporal nerves can become inflamed as well. This phenomenon is known as referred pain.
And because headache pain in the eyes and temples is often just referred pain coming from compression in the neck, fixing the neck nerves sometimes eliminates eye/temple headaches too. This is why in my case Dr. Peled suggested decompressing the neck nerves and waiting 3-6 months to see if the nerves in my eyes and temples would calm down as a result.
Well it's been 3 months now and I continue to have frequent but relatively mild pain in my eyes and temples. Just like before, I wake up with this pain. This pain is occurring 2-3 times per week with an average level of 3/10 and an average duration of about 4 hours.
And this pain is very responsive to triptans. I have used Zomig nasal spray exactly 6 times since surgery on December 2nd with a 100% rate of reducing the headache to a 0/10 within 2 hours.
I will most likely have a follow-up migraine surgery with Dr. Peled in April to decompress my zygomaticotemporal, supraorbital and supratrochlear nerves. I'm hoping that after this second procedure my headaches will be 100% cured.
Recovering from migraine surgery has been smooth sailing for me. Before surgery, I had read a lot of fear-talk about the recovery process. I found none of it to be true.
My neck's range of motion was limited for the first month. I had a hard time driving my car in reverse or quickly checking my blind spots, that sort of thing. That is about the extent of my disability in the wake of migraine surgery.
Since about day 35, I've been between 80-100% and engaging in all of my normal work and other activities.
I believe that the key to my speedy and painless recovery has been my habit of massaging the surgical site twice a day since week 3. This is not something Dr. Peled advised me to do. Actually, I haven't mentioned it to him. But I have found it very helpful.
Presently I'm convinced that the main reason so many people struggle with migraine surgery recovery is because they allow their neck and scalp to become stale, stagnant and painful through non-use and non-touch in the wake of surgery.
It is easy for this to happen. With all the incisions and numbness it is natural to want to keep as much distance as possible from the site of surgery.
I have found it very beneficial not to fall into this trap.
Massaging the neck and scalp keeps these areas online. Pressing into them with your fingertips promotes blood flow which leads to healing. And just as importantly, massaging through the pain and stiffness teaches you that your post-op neck is a lot stronger and more durable than you think.
I started massaging around my incisions on day 15 after taking my bandages off. I used extremely light pressure with just my finger tips–I wasn't sure if my incisions would reopen with too much force.
But I quickly realized that the incisions were more robust than they felt. By day 18 I was running my fingers directly beside the incisions and applying more and more pressure.
It felt like I was breaking up weeks worth of coagulated stiffness. The pleasure was amazing.
Eventually, I ended up with the following routine which I performed twice a day: first thing in the morning and last thing before bed.
How to Self Massage After Migraine Surgery:
This massage routine has kept my neck loose and limber following surgery. If I skip even one night of massage I feel a significant increase in neck stiffness the following morning.
Stay in touch with your neck. Keep it online. Touch it often after migraine surgery.
I cannot overstate how tremendous my experience with Dr. Peled has been. I am not exaggerating when I say that he is the most impressive physician I have ever met.
I think he is outdone only by his wife, Dr. Anne Peled, who is a highly respected, life-saving breast cancer surgeon.
Dr. Peled site-marking before surgery. These were some of my final moments as a migraineur.
My A+ experience with Dr. Peled began with my first phone call to his office when I spoke with practice manager Cary-Anne Alvord. She was kind, attentive and seemed genuinely concerned about my dire headache situation.
Since the very beginning, Cary-Anne has been patient and available and has made arranging the ins and outs of meeting with Dr. Peled a piece of cake. A practice manager can make or break a medical experience and Cary-Anne is fantastic.
Before ever meeting Dr. Peled I had read many of his blog articles and seen online interviews and lectures. I knew that he was brilliant and clearly one of the world's leading experts in peripheral nerve headache surgery.
I was most impressed by his groundbreaking article on the compression topography of the lesser occipital nerve. Other migraine surgeons automatically perform a neurectomy on the lesser occipital nerve. But Dr. Peled has pioneering, expert knowledge in the handful of areas where this nerve regularly becomes compressed.
As a result he is able to offer an individualized approach to dealing with the lesser occipital nerve during surgery. Unlike other migraine surgeons who always remove this nerve, no questions asked, Dr. Peled decides whether or not to perform a neurectomy on a case-by-case basis.
If the nerve can be fixed he will do so and leave it intact. The advantage of decompressing rather than severing the nerve is that sensation to the innervated area is preserved. The patient keeps sensation in that part of their head or neck.
My first meeting with Dr. Peled was a Skype consultation. He spent 45 minutes conversing with my father and I about every last detail of my patient history and everything we needed to know about migraine surgery.
I was surprised that such a high profile surgeon offered us so much time and attention. We ended that first Skype call feeling great about Dr. Peled and about my candidacy for migraine surgery and would book an operation date 24 hours later.
When my parents and I arrived in San Francisco and met Dr. Peled we were again blown away by his expertise and availability. I showed up to my in-person consultation with a throbbing 10/10 headache and he spent close to two hours performing the nerve block diagnostic on me.
The only other time I had spent 2 hours or more in a doctor's office, it was in the waiting room.
Throughout this long appointment, he was happy to answer any and all questions my parents and I had. His responses were all very thorough and very brilliant.
Dr. Peled talks us through the photos he took during surgery.
Dr. Peled's enthusiasm and passion while discussing headaches left no doubt that he was put on this earth to advance humanity's understanding of peripheral nerve headaches and to surgically heal them whenever he could.
As for his surgical skill: what more can be said? The man cured me. He did the impossible. He made over ten years of chronic headaches disappear in a matter of 3 hours.
I had almost no postoperative pain. My incisions have healed well without complication since the beginning. Now they are almost completely painless and hardly visible at all.
After all Dr. Peled is a plastic surgeon. Finish work is his forte.
Here's what my scars look like exactly 3 months after surgery. The following photos were taken on March 2, 2018.
Three months ago at my first post-op Dr. Peled would not let me thank him for giving me a new life. It was too soon then, but it isn't now. Dr. Peled–thank you.
Under his knife I've been cured from of a chronic headache condition that I was certain would handicap me as long as I lived.
He is my hero and I hope that this post will lead other migraineurs into his healing hands.
Dr. Peled relieved my headaches by decompressing my occipital nerves. But to understand the root cause of my headaches we must ask: what caused the nerves to be compressed in the first place?
Just to clarify: the following ideas are my own, not Dr. Peled's.
I believe that in my case my occipital nerves became compressed as a result of a lifetime of poor neck posture.
To go one step further down the rabbit hole, I'm actually convinced that my poor neck posture was itself just a byproduct of the true root cause of my headaches: abnormal facial growth that began in my infancy.
It works like this:
This is why in addition to migraine surgery I am growing my palate forward with the Anterior Growth Guidance Appliance and leveraging the increased space in my mouth to develop proper tongue and neck posture.
By developing proper tongue and neck posture, I am ensuring that my neck will never bear excessive stress and strain again.