Peripheral nerve field stimulation to the preauricular area for intractable chronic migraine: a case report

Objective: To report a successful attempt of peripheral nerve field stimulation (PNFS) in preauricular area to treat refractory chronic migraine (CM). This article focuses on novel utilization of PNFS and discusses its existing issues. Case report: A 35-year-old woman diagnosed with CM complained about a 2-year history of severe pain at the occipitocervical and left auriculotemporal area, sometimes bilaterally, which did not benefit from conventional medical therapy. After failed attempts of occipital nerve stimulation and PNFS at the retroauricular area, we used exploratory PNFS at the preauricular area, which to our knowledge is the first reported case in literature, to such an area in refractory CM. The patient experienced satisfactory pain relief and obvious improvement in quality of life. And the amelioration on the severity of pain was validated by reduced scores (from 9 to 2) on the numerical rating scale. The clinical effects continued in the next 2-year follow-up after the implantation, without adverse events. Conclusion: PNFS is a promising and safe neuromodulation therapy for refractory CM. Facial areas like preauricular region are applicable for lead implantation. Nevertheless, the underlying mechanisms are still unverified, and there is still a lack of standardized operation guides of PNFS. Large-scale randomized clinical trials should be conducted to further validate these findings.