Green Adam, Issa Mohammed A, Kim Chong H
West Virginia University School of Medicine, USA.
Yale University School of Medicine, USA.
W V Med J. 2013 Nov-Dec;109(6):24, 26-8.
Chronic daily headaches can be debilitating. Multiple treatments have been suggested with varying degrees of success. We present a case of a 27-year-old female with greater than ten years of chronic daily headaches. The patient was evaluated at the headache clinic where she was diagnosed with complex migraine with components of occipital neuralgia. Multiple medication regimens were tried without significant benefit. The patient also underwent bilateral occipital blocks along with trigger point injections of various muscles including the semispinalis capitis with significant but limited duration of benefit. After other treatments were unsuccessful, the patient was referred to the Pain Management Center and underwent a trial of peripheral nerve stimulation with significant pain relief without complications. She then proceeded with permanent implantation of the peripheral nerve stimulator with continued pain relief. This case demonstrates the utility of peripheral nerve stimulation for the treatment of refractory chronic daily headaches and should be part of our armamentarium.
慢性每日头痛可能使人衰弱。已经提出了多种治疗方法，取得了不同程度的成功。我们报告一例27岁女性，患有超过十年的慢性每日头痛。该患者在头痛诊所接受评估，被诊断为伴有枕神经痛成分的复杂性偏头痛。尝试了多种药物治疗方案，但没有明显效果。患者还接受了双侧枕部阻滞以及包括头半棘肌在内的各种肌肉的触发点注射，获益显著但持续时间有限。在其他治疗均未成功后，该患者被转诊至疼痛管理中心，接受了外周神经刺激试验，疼痛明显缓解且无并发症。随后她进行了外周神经刺激器的永久植入，疼痛持续缓解。该病例证明了外周神经刺激在治疗难治性慢性每日头痛中的作用，应成为我们的治疗手段之一。
