Refractory headaches treated with bilateral occipital and temporal region stimulation

Abstract

Objectives

To describe use of bilateral temporal and occipital stimulator leads for a refractory headache disorder.

Materials and methods

A 31-year-old female had a 10-year history of chronic, severe occipital and temporal region headaches. The patient underwent permanent implant of an occipital stimulator system that resulted in sustained, compete resolution of her occipital pain. However, she continued to suffer disabling (10/10) temporal region headaches and was bedbound most days of the week. Therefore, bilateral temporal stimulator leads were implanted and tunneled to her internal pulse generator.

Results

At 12-month follow-up, the patient enjoyed sustained improvement in her pain scores (8/10) and marked increase in her level of functioning. Taking into account increased activity level, she rated her overall improvement at 50%. Unfortunately, infection and erosion of her right temporal lead necessitated temporal stimulator removal.

Conclusion

Headache disorders may require stimulation of all painful cephalic regions. However, our success in this case must be considered in light of the technical challenges and expense of placing stimulator leads subcutaneously around the head and neck, including the risk of infection, lead breakage, erosion, and migration.

Keywords:

• headache
• occipital nerve stimulation
• peripheral nerve stimulation
• migraine
• cluster headache

Author contributions

All authors collected and analyzed information for the report, and contributed to preparation of the manuscript. All authors reviewed the manuscript critically and approved the submitted version of the manuscript. The authors agree to be accountable for all aspects of the work and will ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

Within the past 5 years, Drs Trentman and Dodick have received research support from St Jude-Neuromodulation and Medtronic Inc. Dr Dodick has provided consulting services within the past 3 years for Medtronic, Inc., and Boston Scientific Corporation. In the remote past (>3 years), Drs Trentman and Zimmerman provided consulting services for Advanced Bionics Corporation, now Boston Scientific Neuromodulation. The authors declare that no financial support was given towards the preparation of this manuscript.