Effective Treatment of Postherpetic Neuralgia at the First Branch of the Trigeminal Nerve by High-Voltage Pulsed Radiofrequency

Background: Postherpetic neuralgia (PHN) is one of the most common and serious complications of herpes zoster. PHN of the first branch of the trigeminal nerve is painful and difficult to treat, as no definitive effective treatment is available. The aim of this retrospective study was to observe the efficacy and safety of treatment of PHN of the first branch of the trigeminal nerve with high-voltage pulsed radiofrequency (PRF) of the supraorbital nerve.Methods: Fifty-two patients diagnosed with the PHN of the first branch of the trigeminal nerve at the Department of Pain Management, Shengjing Hospital, China Medical University, between April 2017 and October 2020 were selected. The PRF treatment of the supraorbital nerve was used. The patients were divided into two groups according to the treatment received: group C, conventional PRF group; and group H, high-voltage PRF group. The basic conditions, pain scores, and SF-36 scores of patients before treatment were recorded. Also, intraoperative and postoperative adverse events, visual analog scale (VAS) scores, 36-Item Short Form Health Survey (SF-36) scores at 1 week, 1 month, 3 months, and 6 months of follow-up were recorded. Furthermore, treatment efficiency was followed up at 6 months after treatment.Results: The VAS scores of patients in both groups were significantly lower at all time points after treatment compared with presurgery. VAS scores in group H were lower than those in group C 1, 3, and 6 months after treatment. SF36 scores of patients in group H were better than those in group C 1, 3, and 6 months after treatment. The treatment efficiency at 6 months after treatment was higher in group H than in group C. No serious adverse events occurred in both groups.Conclusion: The efficacy of the high-voltage PRF of the supraorbital nerve in treating the PHN of the first branch of the trigeminal nerve was superior to that of conventional PRF. It was a safe and effective treatment method.

Effect of Cervical Mobilization and Transcutaneous Supraorbital Nerve Stimulation in Migraine Without Aura

Migraine is one of the most common disabling headache disorders which is categorized into two broad types based on the number of headache days. It is called episodic or general migraine if the attacks occur less than 15 days per month, and it is categorized as chronic or transformed migraine if headache occur on 15 or more days per month. This study was conducted to find out the effect of strategy for pain using a modality and strategy using mobilization in reducing disability, frequency and pain in migraine without aura. Thirty-Two subjects were selected based on diagnostic criteria for migraine and divided into two groups. Group A received Cervical Mobilization and Myofascial Release with home exercise program and Group B received Transcutaneous Supraorbital Nerve Stimulation with home exercise program. Visual Analogue Scale, Questionnaire (HIT-6) were recorded as outcome on baseline and after 3 weeks. Results showed significant improvements in both the groups with, p<0.01. Between group comparisons elicited non-significant differences with p˃ 0.05. Following the results, it can be concluded that cervical mobilization and Transcutaneous Supraorbital nerve stimulation can be added as a valuable adjunct to medical management in the treatment of migraine without aura.

Microsurgical decompression of the supraorbital nerve in the treatment of chronic neuropathic pain in the frontal-temporal area

Chronic headache is common. One of the causes of frontal-temporal pain may be compression of sensory nerves from the trigeminal nerve system, for example, the supraorbital nerve. Our study involved 12 women with symptoms of supraorbital nerve neuralgia resistant to drug correction. He underwent microsurgical decompression of the supraorbital nerve. The results of the operation were assessed by the change in the level of neuropathic pain using the PainDetect questionnaire and the degree of psychosocial maladjustment of the patient according to the MIDAS questionnaire, before and after the operation. The data obtained indicate a significant decrease in the level of neuropathic pain in patients 1 month after surgery and a significant minimization of the effect of headache on the quality of life in patients 3 months after surgery. Two out of 12 women did not notice any improvement, which required repeated delayed revision and extended proximal decompression of the supraorbital nerve with dissection of m. corrugator supercilii fibers. After the myotomy, pain regression was achieved and the patients noted that they were satisfied with the result.