An approach that provides relief in 93% of patients

For too long, headache and migraine pain has been treated as a medical issue, attempting to address the PHYSIOLOGY rather than the ANATOMY of the painful symptoms. ANATOMY refers to the structures of the body, and problems with body structures are usually dealt with by surgeons.  For example, if your appendix is inflamed, this is a problem of anatomy and is fixed by a surgeon removing your appendix.

In contrast, neurologists often think about headaches in terms of PHYSIOLOGY.  Physiology refers to the chemical interactions in the body and are usually addressed with medicines by medical doctors, like neurologists. The neurology approach to headache pain has centered around chemical imbalances, reactions inside the brain, and the pain signals that are involved in the chemistry between cells inside the brain. Medications have been the mainstay of headache treatment, trying to address and block these chemical reactions inside the brain. Sometimes, medications do work.

Some medications work better than others in certain people, and neurologists and headache patients alike have learned that there are no medications that work consistently in most patients. For example, commercials for one of the newest migraine medications (a CGRP inhibitor) claim to prevent up to 50% of migraine pain in some people when doses are repeated. This medication attempts to work in the brain to block some of the chemicals that transmit pain.

While this physiology is indeed part of the headache pain picture, new research centered on the ANATOMY of migraine pain has revealed the causes for these chemical imbalances. In many if not most cases, these causes lie outside of the brain, in the peripheral nerves of the head and neck. Irritated and compressed nerves that lie in muscles of the neck or just under the skin of the forehead seem to be the triggers that start the cycle of pain chemistry in the brain. These nerves can be easily accessed using outpatient, minimally invasive decompression procedures. Nerve decompression allows theses nerves to lie in a much more relaxed state, no longer triggering the pain cascade in the brain.


A small procedure outside of the brain has huge implications for pain inside of the brain.

Many neurologists point to the genetic aspects of migraine as a very significant contributor to pain and migraine symptoms.  In fact, this provides strong evidence for the anatomic cause of migraine and the success of migraine (nerve decompression) surgery. Clearly, anatomy and structures of the body are inherited from parents.  This is the “genetic” basis of why you look like your mother and father.  If your parent is tall, you are likely to be tall. If your father has a big nose, you might get that nose from your dad.  If your mother has small ears, you may get those ears from your mom.  Unfortunately, if your mother or father has tight bands of tissue pushing on a nerve in their forehead or neck, you may get THAT from your parent too.  This provides a clear understanding of how migraines can be genetic AND related to anatomy, and therefore fixable by the surgical release of the compressing tissue on the problematic nerve.

The basis of migraine nerve decompression surgery is to release the nerves in the neck and the forehead from nearby tissue that is pushing on the nerve.  Without surgery, the compression from nearby tissues causes distress signals from those nerves to trigger headaches in the brain. Releasing these nerves from those irritating structures prevents these signals from causing headache pain after surgery.

In contrast to the newest migraine medication, nerve decompression is a short outpatient procedure with significantly better outcomes. Note the stark differences between medication and decompression – the differences in expected results are remarkable.


Nerve Decompression Medication claims
Over 50% relief in 93% of patients Up to 50% relief in some patients
100% relief in nearly 40% of patients Up to 50% relief in some patients
Provides permanent relief Medication needs to be repeated by monthly injection
Minimal risk of permanent numbness or paresthesia Risks of allergic reaction, injection site reactions, constipation that may require hospitalization and surgery, high blood pressure, other risks

A picture is worth a thousand words… And maybe years of pain relief

In surgery, the irritating compressing tissue that is causing nerve distress and migraine pain is often very easy to see.  Dr. Lowenstein has many photos clearly showing the anatomic basis of migraine pain, and several can be found on our website.  Please be aware that these intra-operative photographs are graphic in nature as they are taken during surgical procedures.  If you feel that you are interested in seeing these photos, we encourage you to see for yourself how the ANATOMY, rather than PHYSIOLOGY, may be the cause of your headache or migraine pain.


If you have questions about migraine surgery or want to find out if you are a candidate for this procedure, please contact our facility by email or call us at 805-969-9004.  The process to see if you may benefit from migraine surgery is very straightforward and involves targeted nerve blocks that you can learn about here.  If you are want to hear from patients like you who have had migraine surgery, listen to our previous patients on this page.  Our website is meant to provide you the education and knowledge you need to make the best choices in your quest for migraine relief, and Dr. Lowenstein would be honored to be the final step in that journey.

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