Background: Despite the various modalities available for treating headaches, typical therapy
does not provide adequate pain relief for some patients.
Objectives: This study explored the efficacy and safety of long-term peripheral nerve stimulation
(PNS) for intractable chronic headaches.
Study Design: Retrospective study of refractory headache patients at academic pain center.
Methods: The medical records of all patients (N = 46) permanently implanted with PNS
between January 2005 and January 2012 were reviewed retrospectively. Patient records and
phone interviews were used to quantify the levels of pain intensity, headache days per month,
and overall patient satisfaction with treatment. The correlation between headache duration and
effectiveness of PNS was also assessed.
Results: Pain intensity on the 11-point Numeric Rating Scale decreased from 7.60 ± 1.73 before
implantation to 3.78 ± 2.41, 3.32 ± 2.67, 3.42 ± 2.74, and 2.04 ± 2.27 at one, 6, 12, and >
12 (19 – 98) months after implantation, respectively (P < .001). The mean number of headache
days per month decreased by about 14 days from the base line. No correlation (r = -.33) was
found between the number of years the patients had suffered from headaches and the efficacy
of treatment.
Limitations: Due to the limitation of a retrospective study, the data collected via chart reviews
and phone interviews are susceptible to selection and information biases.
Conclusions: PNS is an effective modality in the long-term management of intractable chronic
headaches. Despite long histories of chronic headaches, the majority of patients had significant
reductions in pain scores and the number of headache days per month. The outcomes were
not dependent on the number of years the patients had suffered from headaches before PNS
treatment.
Key Words: Migraine headache, refractory headache, chronic daily headache, occipital
neuralgia, cluster headache, hemicranias continua, refractory headache, occipital nerve
stimulation, peripheral nerve stimulation