It can be combined with occipital nerve stimulation to cover large areas of ... Pulsed radiofrequency mapping of the supraorbital nerves led to improvement in ...
COMBINED OCCIPITAL AND SUPRAORBITAL NERVE STIMULATION FOR TREATMENT OF REFRACTORY MIGRAINE HEADACHES Dr A. Al-Kaisy, Dr D. Pang, Dr C.Fenech
Pain Management and Neuromodulation Centre, St Thomas’ Hospital, Westminster Bridge Road, London, UK
Introduction
Results
Chronic refractory migraine is estimated to affect 1.3 – 5.1% of the global population (1) Once medical therapies and other conservative have been exhausted, patients with migraine often have little choice but to self-manage their symptoms. (2) Neuromodulation is a possible treatment that can improve their lives and reduce their medications. Occipital Nerve Stimulation has been used in various primary headache syndromes with positive results. (3,4, 5)
The leads places are shown below. Cross talk between the ONS & SNS provided parasthesia coverage for the whole head. Using the stimulator led to pain relief and she was able to wean off all her migraine medications. She was able to adopt a normal facial posture and return to full time work. No complications were noted.
Conclusion The use of a single lead to stimulate both supraorbital nerves is a promising treatment in refractory migraines. It can be combined with occipital nerve stimulation to cover large areas of pain.
Methods This 33 year old lady presented with refractory migraine; despite optimized pharmacotherapy and other conservative measures she had severe headaches associated with facial weakness, photophobia and eyelid drooping. Pulsed radiofrequency mapping of the supraorbital nerves led to improvement in pain and facial symptoms. Therefore combined of Supraorboital Nerve Stimulation (SNS) and Occipital Nerve Stimulation (ONS) were implanted. This was achieved by a single Octopolar lead at the forehead to stimulate both supraorbital nerves and two Quad Plus leads to cover the occipital nerves, via a percutaneous approach. Stimulation used multiple cathodes at a frequency of 40 Hz and pulse width of 360ms.
References 1. 2. 3. 4. 5.
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