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San Francisco
(415) 751-0583February 26, 2026 | Occipital Neuralgia
This is one of the most common questions raised in my office. In my view, stress is an underrecognized but meaningful contributor to many aspects of health, including peripheral nerve function. Here, I will specifically discuss the mechanical forces that stress can generate – forces that are directly relevant to the pathology we address surgically […]
Read MoreFebruary 26, 2026 | Nerve Pain
Over the years, this question has arisen with some regularity, and the explanation is relatively straightforward although it requires some nuance. Consider an arbitrary area of skin or scalp that is innervated by three separate sensory nerves. In practical terms, this means that all three nerves contribute to sensation in the same region of skin. […]
Read MoreFebruary 12, 2026 | Nerve Pain
Like many things in medicine—and in life—a result can be viewed from more than one perspective. A “negative” or “normal” MRI does not mean that nothing is wrong. It simply means that certain serious conditions were not found. And that’s an important place to start. On the positive side, your scan might show: No brain […]
Read MoreFebruary 12, 2026 | Occipital Neuralgia
What Happens to a Nerve Under Long-Term Compression? As I’ve written previously, the occipital nerves can be compressed by a variety of surrounding structures—muscle, fascia, scar tissue, or even nearby blood vessels such as the occipital artery. Patients often understand that compression can cause pain. A more interesting question is: What actually happens to the […]
Read MoreFebruary 12, 2026 | Nerve Pain, Occipital Neuralgia
Over the past week alone, several patients have asked essentially the same question, “Are my tight neck muscles irritating the nerves, or are irritated nerves causing my muscles to tighten?” It’s a fair question, and frustratingly, the answer is often: both. In many cases, it’s less a straight line of cause and effect and more […]
Read MoreFebruary 12, 2026 | Nerve Pain
One of the most important intraoperative decisions a peripheral nerve surgeon must make is whether an injured nerve should be decompressed or transected. These terms are sometimes used interchangeably with “excision,” but that is not technically correct. Excision implies complete removal of a structure—such as a tumor or cyst. Peripheral nerves, however, are not removed […]
Read MoreFebruary 11, 2026 | Nerve Pain
Simple question, somewhat nuanced answer. Basically, nerve blocks are injections of local anesthetic aimed at temporarily and chemically inactivating a nerve – pure and simple. Where things get a bit more complicated is the amount and type of local anesthetic used and if it is mixed with anything else. Each type of local anesthetic has […]
Read MoreFebruary 11, 2026 | Sensation Preserving Top Surgery
Top surgery has become a cornerstone procedure for many individuals seeking gender-affirming care. At its foundation, the operation involves removal of breast tissue (i.e., a mastectomy), combined with thoughtful contouring and reshaping of the skin and chest wall to create a form that aligns more closely with one’s gender identity and aesthetic goals. When performed […]
Read MoreFebruary 09, 2026 | Occipital Neuralgia
People often confuse migraine symptoms with something called neuralgia. The former refers to an often disabling neurological condition characterized by severe and sometimes frequent headaches. The latter literally means “nerve pain” with the implication that the condition in question is secondary to some type of nerve injury or dysfunction. While migraines can be sub-classified in […]
Read MoreNavigating chronic pain can feel isolating. You don’t have to do it alone.
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