Refractory headaches treated with bilateral occipital and temporal region stimulation

Abstract

Kelly J Zach,1 Terrence L Trentman,1 Richard S Zimmerman,2 David W Dodick31Department of Anesthesiology, 2Department of Neurosurgery, 3Department of Neurology, Mayo Clinic in Arizona, Phoenix, AZ, USAObjectives: To describe use of bilateral temporal and occipital stimulator leads for a refractory headache disorder.Materials and methods: A 31-year-old female had a 10-year history of chronic, severe occipital and temporal region headaches. The patient underwent permanent implant of an occipital stimulator system that resulted in sustained, compete resolution of her occipital pain. However, she continued to suffer disabling (10/10) temporal region headaches and was bedbound most days of the week. Therefore, bilateral temporal stimulator leads were implanted and tunneled to her internal pulse generator.Results: At 12-month follow-up, the patient enjoyed sustained improvement in her pain scores (8/10) and marked increase in her level of functioning. Taking into account increased activity level, she rated her overall improvement at 50%. Unfortunately, infection and erosion of her right temporal lead necessitated temporal stimulator removal.Conclusion: Headache disorders may require stimulation of all painful cephalic regions. However, our success in this case must be considered in light of the technical challenges and expense of placing stimulator leads subcutaneously around the head and neck, including the risk of infection, lead breakage, erosion, and migration.Keywords: headache, occipital nerve stimulation, peripheral nerve stimulation, migraine, cluster headache