Anyone who knows me, knows that exercise has always been an important part of my life.  From my days as a competitive swimmer to my time doing Ironman, sport has always been a source of happiness, pride, and peace.  I always knew that there were physiologic benefits to exercise, for example cardiovascular fitness and muscle strength.  However, it is only after I started treating patients with chronic pain such as

Dr. Ziv Peled recently presented Grand Rounds at Yale University’s Division of Plastic Surgery on the over 20-year evolution of headache surgery. Take a look at the first part of this video to learn more…  

This picture is the first of it’s kind to my knowledge. It is from a recent sensation preserving mastectomy case. The mastectomy has been completed and the sizer is in place to gauge how big an implant to place a few moments later. What you can see is an intercostal nerve that I was able to preserve 8.3 cm of length on before ultimately having to cut it to complete the mastectomy. However, since the patient

I always knew it was just a matter of time and it finally happened.  I was speaking with a patient of mine who was a bit more than one year out from her occipital neuralgia operation.  She was doing extremely well with “over 90% relief” at the one-year mark, when she was diagnosed with COVID-19.  Within a few days, many of her headache symptoms returned, accompanied by a focal swelling

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 a distinct pharmacokinetic (i.e., how the drug is broken down within the body) profile primarily

I was recently asked why some people require more than one operation to obtain optimal relief.  A great question and one with a multi-part answer.   Let me try to break it down in the next few paragraphs. Let me preface these remarks by stating that what I write below is my opinion only and how I approach patients, but should not be considered dogma.  While a number of colleagues also use this approach,

I have been asked recently to write a little something about so-called “rebound headaches”. This topic can be quite confusing, and as you will read, is not very well understood. The precise medical term for this disorder is Medication Overuse Headache (MOH) or analgesic rebound headache. The prevalence of this problem is about 1% in the general population and as with many types of headaches, is higher in women than

Over the years, I seem to have had this question come up on a fairly consistent basis and the answer is actually relatively straightforward.  Let’s take as an example, an arbitrary portion of the scalp which is innervated by 3 different nerves.  What that means is that three different nerves each supply sensation to the same piece of scalp skin.  When someone touches that area, sensation is mediated to some

This query is one of the great ones – a $64,000 question that continues to be raised both in my office as well as online.   What is the difference between neurectomy/muscle implantation (i.e., transection of the nerve and implanting it in the local muscle) and decompression?  Along with this primary query come many misconceptions about the advantages and disadvantages to each.  This post hopes to address some of those

This question is one of the most common articulated in my office and I believe represents an underappreciated component of our everyday lives that can certainly impact many facets of our health including our nervous system function.  In this post, I will focus on the effects of stress on the mechanical forces impacting the peripheral nerves as these forces are what we treat during surgical intervention for occipital neuralgia or carpal tunnel

Take a look at the first picture- it is of a midline incision in the back of the neck.  Can you identify the nerve by the black arrow and the nerve by the blue arrow?  Spoiler alert……don’t look at the second picture just yet. In the second picture, can you identify the same two nerves clearly seen communicating.  How about now….which nerves are these?  Don’t look at the third picture

I’ve noted that there has been some confusion lately over the roles of nerve blocks, nerve stimulators and nerve decompression in the treatment of chronic headaches. To be sure, there will be variations in how each clinician uses these modalities, if only because each patient presents a unique clinical scenario.  While I certainly can’t speak to the ways in which others utilize these modalities, I can offer general guidelines as