Treatment of Cluster Headache Using Peripheral Nerve Stimulation; A Case Report
Alexander E. Yakovlev, MD, Sergey A. Karasev, MD
From Comprehensive Pain Management of the Fox Valley, Appleton, WI
Running title: Alternative approach to cluster headache
INTRODUCTION
Cluster headaches are one of the most severe and disabling types of headache. Control of cluster headaches can be difficult to achieve despite multiple pharmacological modalities available in the field of pain management. Peripheral nerve stimulation (PNS) has been used to treat patients with injuries to a specific nerve [1]; including application to occipital [2-5], ilioinguinal [6], supraorbital [7,8], and trigeminal neuralgia [9]. Recently this type of treatment is utilized to control different headaches including chronic cluster headaches.
MATERIALS AND METHODS
The patient is a 39 year old female with intractable cluster headaches for the past 12 years who failed conservative therapy and had short lasting pain relief after supraorbital and auriculotemporal nerve blocks. She underwent a successful trial of percutaneous placement of an 8-electrode subcutaneous lead (Medtronic Inc., Minneapolis, MN) in the left supraorbital region. During the 2 day PNS trial, the patient reported complete resolution of headaches. Two weeks later the patient underwent subdermal implantation of a permanent lead and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator.
RESULTS
After final implantation, the patient reported excellent control of headaches with the permanent stimulator. The frequency of her cluster headaches significantly decreased from 5–7 per day to 1 episode every one to two months. The patient was able to terminate the cluster headache in 2–3 minutes after turning the PNS on. She discontinued use of all medications including opioids. The patient also reported other positive outcomes including the ability to return to social and occupational activities and improved family relationships. At 12 months post-implant, the patient continued to report good control of the cluster headaches and improved functional status.
CONCLUSION
PNS appears to be a therapeutic alternative for patients with chronic intractable cluster headaches who in the past exhausted all available treatments. This technique is a relatively easy to perform, effective, and safe procedure. The therapy is reversible should patients lose its pain-alleviating effect or headaches resolve.
References
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