Initial experience with implanted peripheral nerve stimulation for the treatment of refractory cephalgia

To report 4 cases of improved pain control and function in patients with chronic cephalgia secondary to chronic headaches and/or trigeminal neuralgia.

Four patients with refractory cephalgia came to our clinic for interventional therapy after medications failure. Each patient underwent a trial with a temporary array of peripheral nerve stimulation depending on the distribution of their pain. Trials varied in duration from 1 to 3 days. Patients who received greater than 50% pain relief during trials were candidates for full implantation. All 4 patients went to full implantation of a permanent peripheral nerve stimulator lead array and generator battery.

After implantation of the permanent lead array and generator, average pain relief among the 4 patients was 60%. Their function improved, and medication usage decreased along with side effects. Overall, all 4 patients reported that they would undergo implantation if given the choice again. Tolerance for medication decreases has varied widely, although all patients were on regimens that were stable and without side effects.

Initial experience suggests that refractory pain secondary to chronic migraines and trigeminal neuralgia may respond to peripheral nerve stimulation. Further studies are indicated to evaluate efficacy over the long term and to elucidate the optimal array and implantation technique.