Dr. Ziv Peled, Peripheral Nerve and Plastic Surgeon, was recently asked to sit down and answer some questions about migraines and migraine relief. Here is a transcript of the interview.
Question: What is a migraine?
Dr. Peled: A migraine is thought to be some type of chemical imbalance, usually in the central nervous system of the brain. Nobody really knows what the chemical imbalance is. This explains why there are many different medications and treatments for migraines. 35 million people have migraines. For many of those people, the medications and other treatments aren't effective.
Q: Why do peripheral nerves matter?
Dr. Peled: There's a theory that migraines are not a problem in your central nervous system, but rather a problem in your peripheral nervous system. The nerves that go to your nose, toes, head and neck area can be irritated or pinched, which can cause people to become symptomatic. No one knows why this happens to some people and not others. As far as we know, it's just bad luck. There's not much you can do to prevent it or treat it with medications or a lifestyle change.
Q:How do you diagnose pinched nerve as a cause?
Dr. Peled: The process begins with a complete history and physical exam. Be sure to bring any previous imaging studies (e.g. an MRI of the brain) in for your consultation. During the physical exam, if the tender areas are found corresponding to potential areas for nerves being pinched, that can be good clinical evidence that a pinched nerve is the culprit in your case. You can then use Botox to relax the muscles pinching the nerve or a local anasthetic if appropriate. If surgery is required, it is performed as an outpatient and through a 5-6 cm incision (in the back of the neck) or a smaller incision in the front or temple if these areas are involved. During surgery, the surgeon finds the nerve and removes a little bit of muscle or connective tissue is to create space for the nerve so it is no longer pinched.
Q: How can a reader find a specialist?
Dr. Peled: This is a subfield of plastic surgery with only about a dozen people specializing in it. Google "migraine surgeries" in your region. Anyone who is also a member of the American Society for Peripheral Nerve practices regularly and should have the proper credentials. You should see a neurologist for a comprehensive workup before seeing a specialist. You will want a migraine diagnosis and an MRI to rule out herniated disc, arthritis, aneurism, or a brain tumor. Only when all the other modalities have failed do you want to consider surgery.
For more information about peripheral nerve surgery, visit.http://peledmigrainesurgery.com