Peripheral Nerve Stimulation: A Possible Last Resort for Intractable Headache

The Clinical Pain Advisor reviews a recent study in Pain Physician supporting the efficacy of an implanted peripheral nerve-stimulating device for chronic intractable headache. Although this device is not yet FDA approved, it may be a last-resort treatment for patients who have not had success using other types of therapy.

If you have ever had a patient with chronic intractable headaches, you know how miserable they can feel. These patients have severe headaches on a regular basis that do not respond to rescue or preventive medications. Most have failed to respond to other modalities including nerve blocks, infusion therapy, Botox injections, or any number of alternative treatments.1

Peripheral nerve stimulation (PNS) — using an implanted neurostimulator, wire leads to the occipital nerve or a peripheral facial nerve, and a programmable controller — has proven beneficial to some patients.

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Although PNS has been studied in headaches since 1966, the US Food and Drug Administration (FDA) still considers its use investigational, citing a high risk for complications in relation to potential benefit.1,2

Now, a new retrospective study takes a fresh look at this procedure and reports some impressive results.

Researchers led by Billy K. Huh, MD, PhD, from the University of Texas MD Anderson Center in Houston, TX, found that 87% of patients implanted with PNS achieved a greater than 50% decrease in headache intensity. Overall, 74.4% of implant recipients were satisfied with the experience and results.

“PNS can offer long-term benefits for patients with intractable headaches and should be considered as a viable treatment option,” the authors write. The study was published in the September-October issue of Pain Physician.1

PNS Slashes Pain Intensity and Frequency

For the study, researchers monitored 46 patients who implanted with a PNS device between 2005 and 2012. Most patients had migraines (n = 36), but some had cluster headaches (n = 11). Depending on the area of pain, electrodes were located near the occipital nerve, supraorbital nerve, or auriculotemporal nerve. More than 50% of patients were treated with occipital nerve stimulation.

Follow-up phone interviews were conducted in 35 patients at a mean of 52 months post-transplantation (range, 19 months – 98 months), to determine subsequent headache intensity, frequency of headaches per month, complications and overall satisfaction with the treatment. Results were very positive on all counts.

Mean headache severity, as evaluated using an 11-point numerical rating scale (NRS), decreased from 7.60 ± 1.73 pre-implantation to 3.78 ± 2.41 after 1 month (P < .001). The mean NRS score at the time of interview was 2.04 ± 2.27 (P < .001), representing a decrease of 73%.