3 Week Migraine Surgery Follow-Up with Dr. Ziv Peled

Today I had my 3 week migraine surgery follow-up appointment.

On December 2, 2017 I had migraine surgery with Dr. Ziv Peled. Here's what he and I talked about today during my 3 week follow-up phone call.


Dr. Peled's main concern during this phone call was the condition of my 3 surgical incisions.

Before the call I took the following photos of scars and shared them with him. Dr. Peled's incisions were masterful and have been healing rapidly. He agreed that they looked healthy.


Odd Pains

I let him know that I was feeling a sharp, acute pain in the area of my left greater occipital nerve when I tried to touch my right ear to my right shoulder. He instructed me simply to back off that motion for a while longer. 

Any Headaches?

He did inquire about my post-surgery headache symptoms, but it is common knowledge in the migraine surgery world that no solid conclusion can be drawn about the efficacy of the surgery for 3-6 months after the procedure, perhaps even longer.

This is because the surgery involves extensive physical manipulation of the very nerves that were causing the headaches in the first place, and they may be so irritated for months following the procedure that no sensations they put out can be trusted.

In other words, you have to assume for several months after migraine surgery that any pain or sensation coming from the nerves is caused by the surgery itself.

Regardless, Dr. Peled did ask "how things were going" and I shared with him that I had reported a total of 4 "headache" days in my journal since the procedure. But, I told him, these headaches were different than my typical pre-surgery headaches in the following ways:

How Postop Headaches are Different

1) The postop headaches were significantly less severe. My headaches were 7/10, 5/10, 6/10, and 4/10. I did not have a single episode that was in the extreme 8-10/10 range, and did not have any so severe that I vomited. Prior to surgery, I would have at least one 10/10 headache per week.

2) These headaches were mostly in my eyes and temples, which are the areas that Dr. Peled did not operate on. Prior to surgery, my headaches would begin and reside mostly in my neck, which is why Dr. Peled chose to operate on my greater, lesser and third occipital nerves.

He knew that I did suffer significant headache symptoms in my eyes and temples, something which we actually confirmed using the nerve block diagnostic, but Dr. Peled said that it was possible that the eye and temple pain was being triggered by inflammation in the occipital nerves.

He used the analogy of a forest fire, saying that the pain may be spreading from the neck to the nerves of the eyes and temples like a wild fire spreading in the wind. He said that in 3-6 months, once my occipital nerves heal from surgery and settle down, that I will be in a position to know whether or not the eyes and temples were bonafide migraine-causing culprits.

Based on the four headaches I have had so far, my gut tells me that these nerves will need to be operated on eventually.

How Postop Headaches are the Same as Always

My postop headaches have been similar in some ways to my typical pre-surgery headaches.

1) I wake up with headaches. 95% of the time I woke up with my migraines. Since surgery, I have woken up with all 5 bouts of headache pain.

2) The character of the pain is similar. The throbbing, achy sensations I am feeling in my eyes and temples is exactly like the pain I felt there during migraines before surgery. This leads me to believe that whatever was causing them before surgery is also causing them now.

3) The triggers remain the same. All of the post-op headaches happened the morning after I stayed up later than usual, or have overeaten or eaten sugar late the night before.

My postop lifestyle is almost identical to my pre-op lifestyle. Since the surgery, I have maintained all of same dietary, exercise and lifestyle habits that I have adopted over the years to manage my migraines.

In other words, the pre-op and post-op variables are identical.