Migraines or Neuralgia? There's a Difference
Migraine surgeons are leading an awakening in headache pathophysiology by drawing a distinction between two types of severe chronic headaches:
1) "migraines"
2) occipital and trigeminal branch neuralgia
Two Schools of Thought
Migraine surgery is a kind of surgical treatment for headaches with jaw-dropping rates of success that far out-do any other known treatment modality for patients who are pre-screened and approved for this procedure.
In my own case I achieved 85% relief from a decade-long headache condition after my first migraine surgery. Four months after my second migraine surgery I am between 95-100% cured.
In order to understand this game-changing new procedure, we must first acknowledge that there are 2 distinct worldviews that exist in contemporary Western medical understanding of headaches.
There is little place for migraine surgery in the outdated but predominant Worldview #1.
Worldview #1 seems to be ubiquitous amongst neurologists and other headache doctors which is why you have never heard of migraine surgery even though it yields miraculous results.
Migraine surgery only makes sense in the context of Worldview #2 which is an up-and-coming, more accurate headache worldview that draws a critical distinction between two very different types of headaches: true "migraines" and neuralgia.
Worldview #2 is being brought to life by cutting edge physicians like migraine surgeon Dr. Ziv Peled.
As far as I can tell Dr. Peled is the world's leading headache expert and healer and is...a plastic surgeon? More on this below.
For now let's juxtapose the outdated headache Worldview #1 and the up-and-coming, superior Worldview #2:
Worldview #1: The Outdated Conventional Understanding of Chronic Headaches
- Premise 1: Doctors assign the term “migraines” to any set of symptoms that presents as severe, recurring headaches.
- Premise 2: Doctors understand these “migraines” to be caused by a chemical abnormality in the brain that must be treated chemically, with pharmaceuticals.
- Conclusion 1: Therefore, any set of symptoms that presents itself as severe, recurring headaches is called “migraines,” is thought to be caused by a chemical abnormality in the brain, and is treated with pharmaceuticals.
In Worldview #1 the word “migraine” is, in a sense, meaningless since there is no other type of severe, recurring headache from which it can be distinguished. “Migraine headache” is synonymous with “severe, recurrent headache.”
According to Worldview#1 all headaches are caused by chemical abnormalities in the brain.
Worldview #2: A Migraine Surgeon's Understanding of Chronic Headaches
- Premise 1: Some severe, recurring headaches are caused by a chemical abnormality in the brain. Such headaches are rightly called “migraines” and ought to be treated with pharmaceuticals.
- Premise 2: Other severe, recurring headaches are caused by mechanical compression of peripheral nerves in the head and neck by various structures such as scar tissue, spastic muscle or abnormal blood vessels.
Such headaches are called “neuralgia” and ought to be treated mechanically by surgical nerve release, i.e. “migraine surgery.”
- Conclusion: Therefore each case of severe chronic headaches must be carefully diagnosed as either chemical (migraines) or mechanical (neuralgia) and treated accordingly.
Migraine surgeons assert that some headaches are caused by mechanical nerve compression. If it can happen to our finger, can't it happen to our head and neck too?
"Migraines" vs. Neuralgia
Therefore migraine surgery arises from the unconventional but rather straightforward notion that some headache pain is not caused strictly by a chemical abnormality in the brain.
Migraine surgeons like Dr. Ziv Peled hold that at least some headaches (perhaps more than you might think) actually arise from causes outside of the skull.
Particularly, Dr. Peled and others have shown that headaches arise from 7 culprit nerves (14 bilaterally) in the neck, eyebrows, forehead, and temples.
The medical term for pain arising from a damaged nerve is neuralgia. It comes from the Greek word neuron “nerve” + algos “pain.”
There are two types of neuralgia associated with headaches:
occipital neuralgia - compression of 3 nerves (6 bilaterally) located in the back of the neck and scalp
greater occipital nerve
lesser occipital nerve
third occipital nerve
trigeminal branch neuralgia - compression of 4 nerves (8 bilaterally) in the eyebrows, forehead, and temples
Supraorbital nerve
Supratrochlear nerve
Zygomaticotemporal nerve
Auriculotemporal nerve
The 7 nerves above (14 bilaterally) are the main headache-causing culprits. In my case Dr. Peled released all 14 of these nerves.
Therefore in the migraine surgeon's worldview a very important distinction is drawn between at least two types of severe, recurrent headaches:
migraines - caused by a chemical imbalance in the brain
neuralgia - caused by compression of peripheral nerves in the head and neck.
So What is "Migraine" Surgery?
Having drawn the distinction between "migraines" and neuralgia, it is actually more precise to say that what migraine surgery treats is not actually "migraines."
It treats occipital and trigeminal branch neuralgia.
The procedure involves releasing nerves in the head and neck that are compressed by scar tissue, abnormal blood vessels, spastic muscle or very tight connective tissue.
This surgical release is performed with a scalpel and tissue-burning tool.
Operating on all 14 nerves requires 7 total incisions:
3 total incisions at the back and side of the neck
an incision concealed in the crease of each eye lid (2 total)
an incision in each temple concealed behind the hairline
Migraine surgery involves the same basic approach that is taken to treat carpel tunnel syndrome, except it is done in the head and neck.
During migraine surgery compressed nerves are released in either of 2 ways:
1) neuroplasty - aka decompression - this involves leaving the nerve intact and simply freeing it from compressing structures
These photos detail the decompression of my greater occipital nerves.
2) neurectomy - aka excision - this involves cutting the nerve upstream of its most-upstream point of compression and burying the live end of the nerve in a nearby muscle.
Once implanted in a nearby muscle, the cut nerve's proximity to motor nerves of that muscle causes it to become dormant. Risk of neuroma becomes negligible.
This particular way of managing excised nerves (burying them in muscle close to motor nerves in order to prevent neuroma) is a refinement of the migraine surgery procedure pioneered by Dr. Peled.
This photo shows my right lesser occipital nerve which was excised.
Between my two migraine surgeries, 9 nerves were excised and 5 were decompressed.
A Well-Intentioned Misnomer
Given all we have discussed, we might even say that the term “migraine surgery” is a bit of a misnomer.
After all, the term “migraines” and “chemically caused headaches” are virtually synonymous and yet migraine surgery does not actually treat chemically caused headaches.
But so many of us headache sufferers, myself included, are given an official diagnosis of “chronic migraines” by neurologists.
Therefore calling the procedure “migraine surgery” makes it more likely that our ears will perk up if we are lucky enough to come across the procedure while Googling or elsewhere.
So perhaps "migraine surgery" is a well-intentioned misnomer.
A more precise name for the procedure might be something like "occipital and trigeminal branch neuralgia release surgery."
My Own Neuralgia Misdiagnosed as "Chronic Migraine"
Drs. William G. Austen and Peled, both migraine surgeons, spotted my neuralgia from a mile away. There were several dead giveaways.
But for years I stumbled through life with a misdiagnosis of "chronic migraines" and was told that my headache condition was caused by a genetic, chemical imbalance in my brain.
Consider this diagnosis which I received from a Boston neurologist in June 2017 just 4 months before I met Dr. Peled. It was my second "chronic migraine" diagnosis that year.
The other came from a top Boston neurologist who I had to wait 6 months for an appointment with.
“He has tight neck muscles, which he appreciates triggers his headaches...
Conclusions: Chronic migraine.”
Despite my emphasis on the cervicogenic nature of my headache symptoms during my consult, this neurologist completely missed the ball on my severe occipital neuralgia.
All these other people missed it too. This is a systemic problem, folks.
Of course, when I was finally diagnosed with occipital and trigeminal branch neuralgia by Drs. Austen and Peled and treated with two migraine surgeries I achieved almost 100% relief from my headaches.
The very purpose of this website is to share that miraculous news.
Conclusion
It is imperative that the migraine surgeon's pathophysiological understanding of headaches become the new paradigm in Western medicine.
A major component of this pathophysiology is the distinction between chemically-caused "migraines" and mechanically-caused neuralgia.
Drawing this distinction sets the stage for providing better treatment to at least some of the 40 million American so-called migraineurs who, in reality, might actually be suffering from occipital and trigeminal branch neuralgia.
