Scalp peripheral nerve stimulation for intractable headache

Objective: The aim of this research was to study the efficacy of scalp peripheral nerves (occipital, supraorbital and auriculotemporal) stimulation therapy for intractable headaches. Background: Intractable migraine and other headache syndromes affect approximately 38 million Americans and millions worldwide. There is estimated to be at least 5% of these headache sufferers with adverse effects on their lives and significant socioeconomic burden who do not respond to medications. Design: Retrospective study. Setting: Combined academic and private pain clinic. Participants: Twenty- two intractable headache patients (5 males, 17 females, age 23-66) were followed from 6 months to 7 years after scalp peripheral nerve stimulation implantation. All of these patients had failed conservative therapies including medication management and local injections. They were referred by headache specialists. Interventions: After a successful trial, all patients underwent percutaneous occipital with or without combined supraorbital or auriculotemporal nerve stimulator implantation using a minimally invasive technique. Main Outcome Measures: Primary outcome measures were assessed by an independent reviewer, which included Total Pain Index (TPI), opioid medication usage, patient satisfaction and ability to return to work. Results or Clinical Course: Nineteen patients reported good to excellent pain reduction with a TPI drop from an average of 486.1 to 48.9. One patient rated fair pain relief with TPI decrease from 364 to 140. Two patients required removal of the stimulator: one was due to skin hypersensitivity to the stimulation leads and the other for religious preferences. Three patients developed late on-set infection from superficial anchors/suture knots requiring lead revision. All twenty patients weaned or significantly reduced their pain medications and returned to work. There were no long-term complications. Conclusions: Scalp peripheral nerve stimulation therapy is an appropriate alternative treatment for intractable headache patients who fail conservative therapy. It can offer significant and prolonged pain relief. Complications of this modality are mild and manageable.