Long-Term Clinical Outcome of Peripheral Nerve Stimulation for Chronic Headache and Complication Prevention

Abstract

BackgroundSubcutaneous peripheral nerve stimulation (PNS) has emerged as a useful tool in the treatment of intractable headaches. However, complications such as skin erosion, infection and lead migration have adversely affected clinical outcome, and occasionally led to treatment cessation.ObjectivesHere we report the results of peripheral nerve stimulator implantation performed on 24 patients with various chronic headaches at our center over a period of 9 years. We describe the complications of the procedure and their prevention with a modified surgical technique.Patients and MethodsWe searched our database for patients with chronic refractory headaches who had undergone PNS. Patients were assessed before being considered for PNS, and their pain characteristics were reviewed. Following a successful trial, patients were implanted with a permanent peripheral nerve stimulator. Selection of target nerves was based on headache diagnosis and head pain characteristics. Patients were followed for an average of 4.9 years. Headache characteristics before and after treatment were compared.ResultsTwenty four patients were included in the study. All patients reported on improvement in head pain intensity, duration and frequency three months after permanent device implantation Mean total pain index (TPI) decreased significantly, from 516 ± 131 before the procedure to 74.8 ± 61.6 at the last follow up (P < 0.00001). There were no acute post-operative infections. Three patients had their stimulator removed. The self-rated treatment satisfaction was excellent in 54% of the patients, very good or good in 42%, and fair in 4%.ConclusionsOur results support the use of PNS in some patients with refractory chronic headaches. Appropriate surgical planning and technique are important to achieve good clinical outcome and to minimize complications.

Increased mechanosensivity of the greater occipital nerve in subjects with side-dominant head and neck pain – a diagnostic case-control study

“…Ambrossini and Schoenen highlighted that a good effect with GON blocks can be expected in subjects with a side-dominant migraine without a side change [17]. As an alternative for the invasive GON block, pericranial GON stimulation is described as an effective treatment [27][28][29]. Furthermore, massaging the GON has been reported as pain relieving by patients with migraine [30].…”

Short-Term Peripheral Nerve Stimulation Relieve Pain for Elder Herpes Zoster Ophthalmicus Patients: A Retrospective Study

“…Peripheral nerve stimulation (PNS) refers to implant a lead near the nerve to stimulate it directly ( 10 , 11 ). This technique has been used to treat intractable various pain, such as occipital neuralgia, cervicogenic headache, PHN, intractable cancer pain, and so on ( 12 , 13 , 14 ).…”

Supraorbital Stimulation for the Treatment of Supraorbital Neuralgia: A Complication of Skin Erosion and Lead Extrusion

“…He proceeded to have a permanent implantation performed under Over the past few decades, there has been growing interest in the use of peripheral nerve stimulation (PNS) to treat refractory headache disorders. Supraorbital nerve stimulation (SONS) is a form of PNS that has been used in the treatment of ophthalmic postherpetic neuralgia, trigeminal neuropathic pain, supraorbital neuralgia, chronic craniofacial neuropathic pain, chronic migraine headaches, and chronic cluster headaches (1)(2)(3)(4)(5).…”