Migraine Surgery Recovery Month 1: Limitations

What limitations have I had during this first month of recovery?

On December 2, 2017 I had migraine surgery with Dr. Ziv Peled. He decompressed my left and right greater occipital nerves, and cut out my left and right lesser and third occipital nerves because they were damaged beyond repair. Today is January 3, 2018.

What surgical side effects did I experience during this first month of recovery?

Best Month of My Life?

After reading so much online about the difficulty of recovering from migraine surgery, I have to say – it isn't half as bad as they make it out to be.

Actually, it has been one of the best months of my life, considering that my migraines have reduced drastically in both frequency and intensity.

In addition, I never had pain or setbacks of any kind with the 3 surgical incisions, was walking the steep streets of San Francisco within 18 hours of surgery, have had no trouble sleeping, and within 8 days of surgery was commuting 2.5 hours everyday to my BMW technician training.

Actually, since surgery I have been more, not less capable.

No Heavy Lifting, No Deep Neck Stretching

All that being said, I have had two limitations during this first month of recovery, both of which came directly from Dr. Peled: 1) no heavy, strenuous lifting and 2) no aggressive neck and shoulder stretching. 

These limitations are aimed at preventing one thing: the dislodging of the 2 lesser occipital nerves and 2 third occipital nerves that Dr. Peled buried in muscle as part of the neurectomy he performed on them.

Neurectomy and Heavy Lifting

Allow me to explain: a migraine surgeon has two options when dealing with damaged nerves that cause migraines:

  1. neuroplasty, i.e. decompression - involves freeing the nerve from surrounding muscle and other tissue or structure that are pinching the nerve.
  2. neurectomy, i.e. severing the nerve - involves cutting the nerve upstream of its first damaged section and burying the remaining upstream (live) end of the nerve deep into muscle.

The method used to perform a neurectomy during migraine surgery, especially how best to deal with the remaining live end of the severed nerve, continues to be researched and improved upon by brilliant surgeons like Dr. Ziv Peled.

Nerves, when they are cut, are at risk of developing a condition called neuroma, in which the cut end develops a sort of scar tissue which can be very painful.

There are many effective ways of fixing neuromas when they occur, but the best approach to dealing with them is, of course, to prevent them from occurring in the first place.

And Dr. Peled is confident that the best way to do so is to bury the live end of the cut nerve deeply into neighboring muscle, which causes it so fuse with the muscle in such a way that the cut nerve end becomes dormant, perhaps like burying a live electrical wire into a pool of non-conductive foam.

The issue, though, is that it takes a while for the nerve to fuse into its new home in the muscle. And making the wrong motion or straining too much too soon after surgery can cause that nerve to pop out of the muscle.

Dr. Peled admitted that of the hundreds (perhaps thousands?) of patients he has operated on, only one has had a buried nerve pop out of its host muscle. And this happened 6 months after surgery when the patient was lifting logs on his farm.

And, actually, it happened to a nerve in his groin that Dr. Peled had operated on (he was not a migraine surgery patient).

Neurectomy and Heavy Lifting: In Conclusion

So all of my post- migraine surgery limitations–no heavy lifting, no straining, no aggressive stretching–are all aimed at preventing my four severed, buried nerves from slipping out of their host muscles.

I want to give the nerves a chance to become more enmeshed with the muscle before I start pushing things too much physically.

Dr. Peled told me that at the one month mark, I could start phasing in normal, heavier exercise (in addition to the light exercise and therapy I have been doing since day 1).

As always, I will do my best to be aware of my body and the messages it's sending as I proceed.

Learn more about the status of my headaches and how I managed my incisions during the first month of migraine surgery recovery.