Peripheral Nerve Stimulation for Chronic Headache

Electric stimulation of peripheral nerves shows promise as a long-term treatment for patients with chronic headache, according to the results of a new study presented on October 13, 2013, at the Anesthesiology 2013 annual meeting in San Francisco.

“Chronic headache patients do not have to suffer or resort to polypharmacy without efficacy. There is a viable option to significantly improve headache and regain quality of life,” lead author Billy K. Huh, MD, PhD, Professor and Medical Director of the Department of Pain Medicine at The University of Texas MD Anderson Cancer Center, Houston, and Adjunct Professor of the Department of Anesthesiology at Duke University Medical Center, Durham, North Carolina, told ConsultantLive.

Dr Huh noted that the more than 45 million Americans experience chronic headaches.

“Despite advances in headache treatment over the past two decades, many people do not get adequate pain relief from current treatments, or they cannot tolerate the side effects of the medications,” said Dr Huh. “This treatment offers hope to those patients and a chance for a major improvement in quality of life.”

With electric stimulation of peripheral nerves, a thin insulated wire is implanted in the back of the head (the occipital nerve) or in the forehead above the eyebrow (supraorbital nerve) and delivers electric pulses to block pain. The current study looked into the safety and long-term efficacy of this treatment. The researchers monitored 46 patients who received peripheral nerve stimulation between 2005 and 2012. Follow-up phone interviews were conducted to determine subsequent headache intensity, frequency of headaches per month, complications, and overall satisfaction with the treatment.

Both headache intensity and frequency decreased significantly. The average headache intensity was reduced by more than 70%. The average number of “headache days” decreased from 28 to 14 per month. Virtually all (90%) of patients were satisfied with the treatment, with one reporting more than 8 years of reduced headache intensity and frequency, Dr Huh said.

A drawback of the treatment is its relatively high level of complications, including electrode migration, equipment problems, and infection. As physicians gain experience with implantation techniques, complications appear to decrease.

“The most common complication is electrode migration and infection,” said Dr. Huh. “This can be mitigated by better sterile and implant techniques. Over the last 9 years, my complication rate has decreased dramatically as I learned from my own shortcomings.”

“This is a real breakthrough for chronic headache sufferers,” he continued. “For patients with no other options to relieve their pain and suffering, this treatment is a way for them to get their life back.”

Although the mechanism of how peripheral brain nerve stimulation works is not yet clear, it is “thought to increase serotonin levels in the brain and also via direct inhibition of nociceptive input,” Dr Huh said.
 
The best candidates for this treatment, he concluded, are “those patients who have failed all conservative therapies and have no other options available to manage headache.”