Where Have I Been? A New Book and Patient-Inspired Essays

00:04 — Announcer:

Welcome to the Headache 360 Podcast, a place to listen and learn about the diagnosis and treatment of chronic headache and migraine pain, because information can be the best medicine.

00:21 — Dr. Lowenstein:

Well, hello again after a long while. I am your host, Dr. Adam Lowenstein, and it has been a minute. I’ve been very, very busy and arguably negligent as far as getting these podcasts together and content out to my listeners.

00:44 — Dr. Lowenstein:

I remain humbled by everybody’s continued listening to the podcast and by the number of awards we’ve received for the headache-related content we’ve put out.

01:06 — Dr. Lowenstein:

Again, I’m very grateful to everybody who’s listening and, obviously, to all my patients who have been listening to the podcast as well.

01:28 — Dr. Lowenstein:

Let me tell you what I’ve been doing. Number one, I’ve been operating and taking care of patients. Number two, I’ve been writing a book that is finally done. It was published last month or so, and it is called Headache Surgery: A Path Forward.

01:49 — Dr. Lowenstein:

I’m really excited about it. It’s actually the only patient-facing book about headache surgery out there. There are a couple of books about headache surgery for surgeons that explain, on a technical level, how to perform the surgery.

02:12 — Dr. Lowenstein:

But there has never been a book that explains the procedure, and really why the procedure works, in layman’s terms for the public.

02:32 — Dr. Lowenstein:

…and some of the major problems with the healthcare system as it relates to migraines and chronic headaches.

02:57 — Dr. Lowenstein:

…but also occipital neuralgia, new persistent daily headaches, and tension headaches. All of these things are covered in the book, as well as literally how we do the surgery, with photos and diagrams, and what happens during recovery.

03:21 — Dr. Lowenstein:

I’m really proud of it. It took a lot of time, and it actually took a lot of money.

03:45 — Dr. Lowenstein:

…the book educates and empowers people to look past what they’ve been told and explore other options for long-term relief, as so many people have. Another important thing is that the book includes stories from several of my patients and goes…

04:10 — Dr. Lowenstein:

…through their experiences with surgery and how their lives have changed after finding headache relief.

04:31 — Dr. Lowenstein:

…all-encompassing. In parallel with that, I’ve also written some patient-inspired essays that relate back to the book to some degree. The book is a little more hands-on, with…

04:53 — Dr. Lowenstein:

…photos, descriptions, and plain language about what the surgery entails. But I’ve also been writing these essays, and I’ve shared them with a couple of patients who really enjoyed…

05:13 — Dr. Lowenstein:

…them. As an ongoing return for the podcast, I thought I would read an essay in podcast form. These are going to be much shorter podcasts than we’re used to.

05:33 — Dr. Lowenstein:

The essays are not extraordinarily long, but I thought I would start today with one of them. The first essay is called “What Causes Migraines?”

05:53 — Dr. Lowenstein:

If you ask 10 different people what causes migraines, you’ll probably get 10 different answers: stress, hormones, chocolate, bad weather, poor sleep.

06:17 — Dr. Lowenstein:

…have shown that many migraines aren’t just neurologic conditions. For a significant number of patients, the cause is anatomical. Specifically, migraines can result from irritated nerves in the scalp and neck that are under constant mechanical pressure. Here, we’re going to explore a different way to think about migraines—not just as a disorder of the brain, but as a…

06:39 — Dr. Lowenstein:

…response to nerve compression that might be treatable.

06:43 — Dr. Lowenstein:

The Usual Story: Chemical Chaos in the Brain Most people are taught that migraines are the result of abnormal brain activity, overactive pain pathways, dilated blood vessels, and neurochemical storms. This model explains why medications like triptans or CGRP inhibitors aim to control neurotransmitters and vascular…

07:05 — Dr. Lowenstein:

…changes. For some patients, that approach works well. But for others, especially those with chronic daily headaches, these treatments fall short. Even with Botox, lifestyle changes, and a rotating cast of medications, the pain remains. That’s when it becomes necessary to look beyond the traditional narrative. A Closer Look: Peripheral Nerve Compression

07:28 — Dr. Lowenstein:

In a large subset of patients, migraine pain doesn’t originate from the brain at all. Instead, it starts at predictable anatomic sites.

07:52 — Dr. Lowenstein:

When these nerves are compressed by surrounding muscle or fascia, they become chronically irritated. This irritation can trigger symptoms identical to a classic…

08:02 — Dr. Lowenstein:

…migraine: throbbing pain, nausea, photophobia, and more. The only difference is where it begins. Another commonly understood nerve compression syndrome is carpal tunnel syndrome. In this case, the median nerve in the wrist gets compressed, leading to pain, tingling, and weakness in the hand.

08:22 — Dr. Lowenstein:

The solution in that case is decompression—removing the physical pressure on the nerve.

08:42 — Dr. Lowenstein:

Wine, weather, hormone shifts, and lack of sleep are all triggers of some type. But when underlying anatomy is the problem, triggers are just that: secondary stressors that aggravate an already vulnerable system. In many patients, decompression of the involved nerve eliminates the system’s overreaction.

09:04 — Dr. Lowenstein:

The same wine that once triggered a two-day migraine becomes tolerable again. The rainstorm doesn’t bring a headache. In short, treating the source lowers the brain’s sensitivity to pain triggers because the constant stream of pain signals has stopped. So, What Actually Causes Migraines?

09:24 — Dr. Lowenstein:

The honest answer? It depends. For some, it’s truly neurological. For others—especially those whose pain always starts in the same location, who have tenderness over known nerve sites, or who respond to Botox or nerve blocks—the cause is physical. Common red flags for compression include pain that starts behind…

09:46 — Dr. Lowenstein:

…the eye or at the base of the skull, reproducible tenderness at specific trigger points, and headaches that respond to localized anesthetic blocks. These patients are often misdiagnosed with treatment-resistant migraine when they’re actually experiencing a form of nerve entrapment.

10:09 — Dr. Lowenstein:

What a Nerve Block Tells Us A diagnostic nerve block, in which a small amount of anesthetic is injected around a suspected nerve, can provide a simple but powerful answer. If the pain disappears while the anesthetic is active, it suggests that the nerve is the pain generator. It’s not a placebo; it’s a map. In surgical studies, patients who respond to nerve blocks are…

10:32 — Dr. Lowenstein:

…most likely to benefit from decompression surgery. For many of these individuals, the blocks are the first time anyone has correctly identified the source of their pain. Why Isn’t This Talked About More? There are several reasons why this treatment isn’t more widely known. For example, specialty divisions.

10:53 — Dr. Lowenstein:

Neurologists don’t typically perform nerve blocks or scalp exams. Surgeons who do often don’t see migraine patients. There are training limitations. Most physicians aren’t taught to assess peripheral nerve pathways…

11:14 — Dr. Lowenstein:

…in the context of migraines. There are also imaging limitations. MRI and CT scans can’t show soft-tissue compression of nerves, so the structural problem remains invisible to traditional diagnostics. A Broader View of Migraine Causes So, can migraines be caused by stress, hormones, or weather?

11:34 — Dr. Lowenstein:

Yes. But those triggers often affect a nervous system already irritated by a compressed nerve. When that pressure is relieved, the system becomes more resilient, and for some, the headaches disappear entirely. It’s time to expand the definition of what causes migraines. They aren’t always just mysterious neurologic storms.

11:55 — Dr. Lowenstein:

Sometimes there is a signal that a nerve is trapped, and that signal can be turned off. So that’s my first little essay. We’ve got a lot of references for that essay. I’m going to publish these essays on our website…

12:17 — Dr. Lowenstein:

…headachesurgery.com. They’re going to be in blog form, and I might also put them together for a second book. I should also let you know that the original book, Headache Surgery, is available on Audible. You can get the book, Headache Surgery: Understanding a Path Forward, on…

12:43 — Dr. Lowenstein:

…Amazon, Kindle, Apple Books, and elsewhere. You can also get the spoken version on Audible. I will tell you that I got somebody else to read the book…

13:03 — Dr. Lowenstein:

…because, as you probably just noticed, my reading is not necessarily smooth. I really appreciate your feedback on the essay. Of course, I would very much appreciate your feedback on the book. I really hope that all of our content is helpful and…

13:26 — Dr. Lowenstein:

…inspiring and empowering. As always, we are here at the Migraine Surgery Specialty Center for consultations and discussions with patients who are looking for long-term headache relief.

13:47 — Dr. Lowenstein:

That’s about it. It’s great to be back. I hope to return on a regular basis. Again, I apologize for my absence.

I hope everybody is doing generally well, and I look forward to talking to you again soon.

14:08 — Dr. Lowenstein:

Hey, everybody. This is Dr. Lowenstein once again, and I have two last things to ask of you.

First, the best thing you can do for fellow headache sufferers is to remember to subscribe to and rate our podcast. The more ratings and subscriptions we get, the more visibility we’ll receive, the more listeners will be able to find us, and the more help and information we’ll be able to provide to the huge population of people who suffer…

14:28 — Dr. Lowenstein:

…from headache pain. Secondly, please remember that the treatment of headaches of all types is very individualized. The purpose of this podcast is not to give medical advice, so please use the information here on this podcast and elsewhere on the internet to broaden your knowledge, but consult with your physician before acting on any information you hear on podcasts, see on YouTube, or read anywhere on…

14:50 — Dr. Lowenstein:

…the internet. I, as a physician, don’t necessarily endorse the opinions or practices of my guests. If you have particular questions that you’d like to consult with me directly about, please call our Headache Surgery Center. Our phone number is 805-969-9004, or you can email us at info@headachesurgery.com. My staff will set up a consultation, and we can discuss your specific…

15:12 — Dr. Lowenstein:

…case over the phone or in person. Our website is filled with information as well, and that is headachesurgery.com. Thanks, and best wishes from all of us here at the Headache 360 Podcast.