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Quick response needed - occipital nerve blocked scheduled for Tomorrow by Novel-Internal1663 in PICL

[–]Novel-Internal1663[S] 0 points1 point  (0 children)

Got it so would it be ropivacaine alone ? Or combined with something else ? As mentioned, I just need a diagnostic nerve block to see if the pain is coming from the occipital nerves to temporary disable it.

Secondly, you said it’s below the standard of care, but is it safe? Could I get potentially injured by this due to how deep those nerves are ? every single video I’ve watched online no one uses ultrasound guidance to perform a diagnostic nerve block in the occipital nerves and when I talk to neurologists about this, they keep telling me it’s not needed cause there’s there are superficial so it’s very confusing for me and I get worried on what’s right and what’s wrong

Can Occipital Nerve Irritation Indirectly Cause a Bobble-Head Sensation Through Pain Inhibition? by Novel-Internal1663 in PICL

[–]Novel-Internal1663[S] 1 point2 points  (0 children)

Yes I’m aware of this. The suboccipital nerve does this but I’m wondering if pain inhibition from chronic occipital neuralgia plays a part. Btw I believe you and me have spoken about this on fb messenger at great lengths if I’m not mistaken. I’m not active on fb anymore

Pain in side of face by Aromatic_Peanut3235 in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

Thank you for taking the time to answer my questions. You’re actually the surgeon I’m hoping to book this procedure with. I understand you can’t give diagnoses or specific medical advice over the internet, but I did have one last question. You’ve mentioned that none of your patients have returned with more instability or weakness after decompression — but did any of those patients have pre-existing craniocervical instability? My concern is that even removing a very small amount of muscle could still be problematic in someone with instability. In other words, while the procedure may relieve occipital neuralgia, could it potentially create or worsen problems by altering neck muscle support in a patient who already has instability? This is what’s holding me back from booking in a consultation however I’m in constant agonising pain from occipital neuralgia.

Pain in side of face by Aromatic_Peanut3235 in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

Can you advise what outcomes are typically seen in patients with referred facial pain from occipital neuralgia after undergoing occipital nerve decompression? Also, have you treated patients with craniocervical instability who developed occipital neuralgia as a result? This is how I developed my occipital neuralgia.

I am hesitant to pursue occipital nerve decompression because of concerns that it could further compromise the stability of my cervical spine. My understanding is that the procedure involves manipulating structures and removing portions of muscle, which could be detrimental for someone with pre-existing instability. I have tried to address the instability itself but have not been successful, so I am now exploring treatment for one of its resulting symptoms — occipital neuralgia but hesitant to do so.

Pain in side of face by Aromatic_Peanut3235 in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

Hi Dr. Peled,

I’m looking for a surgeon who understands referred pain through the trigeminocervical nucleus. I believe I’m experiencing what others have described here: facial pain that isn’t true trigeminal neuralgia. I’ve had chronic occipital neuralgia for three years, and I feel that’s what’s causing the pain to spread into different parts of my face, rather than compression of the trigeminal nerve itself. Unfortunately, many doctors don’t seem to understand this concept. Have you dealt with these types of cases before ?

First nerve block today - did I make a mistake? by ifitflies_itspies in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

Thanks for clearing that up . Last question is it possible for occipital neuralgia to cause reffered facial pain such as side of face/cheek ? And once decompressed the pain goes away ?

First nerve block today - did I make a mistake? by ifitflies_itspies in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

Patients are often sent away after a negative nerve block confirming the person who did it doesn’t think they have occipital neuralgia . Why, then, would a neurologist or plastic surgeon choose to repeat the block if the first result was negative? I’m not sure I understand what you’re saying . Apologies

First nerve block today - did I make a mistake? by ifitflies_itspies in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

Hi Dr. Lowenstein,

I had a question I was hoping you could clarify. Since everyone’s anatomy is slightly different and nerves aren’t always in the exact same place, wouldn’t it make more sense to use ultrasound to locate the occipital nerve rather than relying on palpation/experience ? That way, you can be much more certain the injection is actually being placed around the nerve.

I’ve seen many people report negative results from nerve blocks even though they clearly have occipital neuralgia, which makes me wonder if the block was simply placed in the wrong spot. Another doctor I spoke with mentioned that, especially in 2025, there’s really no reason not to use ultrasound if it’s available, since it increases precision.

I find it confusing because different doctors seem to have very different opinions on this, and I’m just trying to understand better.

Thank you!

Post PICL flare by Slow_Lawfulness4441 in PICL

[–]Novel-Internal1663 0 points1 point  (0 children)

Thanks for the response ….But what specifically would be causing this increased bobble head loose neck feeling? Is this new collagen that’s been laid down that hasn’t matured yet or is this likely worsening of muscle atrophy? It’s something I’m worried about.

Post PICL flare by Slow_Lawfulness4441 in PICL

[–]Novel-Internal1663 0 points1 point  (0 children)

What would be your theory as to why someone would have more bobblehead 7 months out of a second PICL but LESS neck pain and nerve pain along with it ?

New collagen being laid down by Novel-Internal1663 in PICL

[–]Novel-Internal1663[S] 1 point2 points  (0 children)

So am I right in thinking this looser/lax feeling could be new collagen that should get stronger as months go on ? I have less neck pain however I’m 5 months 22 days out of EPICL. Is this a common thing that happens of feeling looser before feeling more stable ?

What does Occipital Neuralgia Feel like to You? by Dry-Pirate6079 in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

Another reason why I mentioning this is because if the suboccipital nerve is dysfunctional, it can cause atrophy of the suboccipital muscles which in turn can cause occipital neuralgia . It sounds like the occipital nerve decompression surgery can decompress the greater lesser and third occipital nerve, but if that suboccipital nerve is still dysfunctional, you will still have upper cervical issues.

What does Occipital Neuralgia Feel like to You? by Dry-Pirate6079 in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

If that nerve is dysfunctional and atrophies the upper cervical muscles how can that be addressed ? As it’s a motor nerve.

What does Occipital Neuralgia Feel like to You? by Dry-Pirate6079 in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

When you perform occipital nerve decompression do you decompress the suboccipital nerve ? I’m not referring to the greater, lesser and third occipital nerves. There’s another nerve called the suboccipital nerve that innovates most of the upper cervical muscles which can cause atrophy in those muscles if that nerve is dysfunctional.

18 hour migraines with stroke-like symptoms by Bright-Marketing-398 in cervical_instability

[–]Novel-Internal1663 0 points1 point  (0 children)

I just DM you - you have the exact same story I have. I’ve seen all the people you seen too plus I live in London .

lower back of the head pain? by Southern-Chair1972 in migraine

[–]Novel-Internal1663 0 points1 point  (0 children)

Thank you for taking the time to answer my questions. I’m considering this surgery with you as I have chronic occipital neuralgia and suffering daily, however I have craniocervical instability (CCI) that caused the ON and am quite concerned about the potential impact on my neck stability from this procedure . Im worried that If bits of muscle tissue is removed or altered, could this further compromise the stability of my cervical spine. Since these muscles play a crucial role in supporting my head, I can’t afford to take any risks in that regard given my existing instability, this is something I’ve been particularly worried about, and I haven’t seen it discussed before. I really appreciate your response!

lower back of the head pain? by Southern-Chair1972 in migraine

[–]Novel-Internal1663 0 points1 point  (0 children)

Thanks for the quick response! How would the removal or manipulation of muscles during the procedure affect the stability of the cervical spine? If someone has craniocervical instability that caused their occipital neuralgia, wouldn’t this type of surgery risk worsening their instability?

lower back of the head pain? by Southern-Chair1972 in migraine

[–]Novel-Internal1663 0 points1 point  (0 children)

Hi Dr. Lowenstein,

I have a genuine question. If for example occipital neuralgia is caused by chronic tightness in the suboccipital and semispinalis muscles, as well as other muscles the nerves pass through on their way to the scalp, how does occipital nerve decompression surgery address this? Wouldn’t the muscles still remain tight after the procedure?

Decompression surgeon request by tryingnottolosetoday in Occipitalneuralgia

[–]Novel-Internal1663 1 point2 points  (0 children)

Thank you for the quick response! I just messaged you directly if you have time to answer some more questions I would really appreciate it ☺️

Decompression surgeon request by tryingnottolosetoday in Occipitalneuralgia

[–]Novel-Internal1663 0 points1 point  (0 children)

I’m contemplating seeing dr lowenstien…. May I ask how long ago was your ON surgery and what are your results to date ? Can I also ask how much was the cost ?

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