Orthopaedic & Spine Center, Columbus, OH 43240, USA.
Pain Physician. 2011 Jan-Feb;14(1):37-44.
Evidence of a paradigm shift towards epicranial neurostimulation treatment techniques aimed at the site of headache pain is beginning to populate the literature. This is most apparent by 2 recently published reports describing alternative approaches to peripheral nerve stimulation techniques for refractory migraine, including hemiplegic migraine.
To contribute to the emerging literature on epicranial-based neuroaugmentative approaches which target site-specific areas of distinct, but relatively diffuse, headache pain. Specifically, we describe the feasibility of a novel neurostimulation technique: occipital nerve stimulation, combined with bilateral subcutaneous electrical stimulation over the temporal region, to treat a patient dually diagnosed with "complicated migraine" and occipital neuralgia. Integral to this report, key stimulation programming data are also presented to better distinguish the role of this form of therapy in migraine, or other headache forms, from both the clinical and biomedical perspectives.
Case presentation with literature review.
At 24-month follow-up, headache onset had been reduced by more than 50%, including cessation of neurologic deficits that accompanied the patient's migraines. No complications or adverse side effects are reported. The programming data reported here supports a proposed mechanism of action concerning stimulation of the auriculotemporal nerve distribution/anterior temporal region for management of refractory pain in migraine.
Case presentation provides only initial assessment of treatment safety, not conclusive evidence of treatment effectiveness. Future studies which consider "follow-the-path" epicranial approaches to peripheral nerve stimulation techniques for refractory headache pain are needed to better quantify outcomes and mechanisms of action.
In the single case reported here, the feasibility of a novel neurostimulation technique (occipital nerve stimulation/bilateral subcutaneous temporal region stimulation) to treat headache is presented. At the 24-month follow-up, no complications (such as loss of coverage due to lead displacement or lead fracture or erosion) or adverse side effects were reported. Finally, inclusion of fundamental programming data in reports on neuroaugmentative approaches to headache care will complement initiatives in research from the clinical and biomedical communities involved in this field.
有证据表明，针对头痛部位的颅外神经刺激治疗技术正在发生范式转变，这一现象开始在文献中显现。最近发表的 2 份报告最能说明这一点，这两份报告描述了偏头痛难治性的外周神经刺激技术的替代方法，包括偏瘫性偏头痛。
为针对特定部位、具有不同但相对弥散性头痛的颅外神经增强方法的新兴文献做出贡献。具体而言，我们描述了一种新的神经刺激技术的可行性：枕神经刺激，结合双侧颞区皮下电刺激，用于治疗同时患有“复杂偏头痛”和枕神经痛的患者。本报告的一个重要组成部分是还介绍了关键的刺激编程数据，以便从临床和生物医学角度更好地区分这种治疗形式在偏头痛或其他头痛形式中的作用。
病例报告结合文献复习。
在 24 个月的随访中，头痛发作减少了 50%以上，包括停止了伴随患者偏头痛的神经功能缺损。未报告并发症或不良反应。这里报告的编程数据支持刺激耳颞神经分布/前颞区用于治疗偏头痛难治性疼痛的作用机制假说。
病例报告仅提供了治疗安全性的初步评估，而不是治疗效果的结论性证据。需要进一步研究考虑针对难治性头痛的外周神经刺激技术的“跟随路径”颅外方法，以更好地量化结果和作用机制。
在本报告的单个病例中，提出了一种新的神经刺激技术（枕神经刺激/双侧颞区皮下刺激）治疗头痛的可行性。在 24 个月的随访中，未报告任何并发症（如因导线移位、折断或侵蚀导致的覆盖丢失）或不良反应。最后，在头痛治疗的神经增强方法报告中纳入基本编程数据将补充该领域临床和生物医学社区的研究计划。
