A case report of a 35-year-old woman with chronic migraine who had a 2-year history of severe pain that did not improve with medical therapy showed that peripheral nerve field stimulation could safely treat chronic migraine.
Peripheral nerve field stimulation (PNFS), also known as subcutaneous stimulation, is a safe neuromodulation therapy for treating refractory chronic migraine (CM), according to a recent study.
The case report, published by Journal of Pain Research, evaluated a 35-year-old woman diagnosed with CM, who had a 2-year history of severe pain at the occipitocervical and left auriculotemporal area that did not improve with medical therapy. The researchers used exploratory PNFS at the preauricular area following failed attempts of occipital nerve simulation and PNFS at the retroauricular area.
“Unlike spinal cord stimulation (SCS) where leads are placed in the epidural space, leads of PNFS are placed into the subcutaneous tissue in the area of pain, thereby subcutaneously stimulating the peripheral nerves and their endings in the corresponding region to reach the spinal cord through the sensory afferent fibers and achieve analgesic effects,” explained the authors. “PNFS is mainly used for lower back pain, failed spinal surgery, head and face pain, and as an adjuvant therapy to SCS.”
During the procedure, the lead was led upward near the left ear, then to the temporal part of the brain through the ear—to the patient’s identified pain area. The patient was unsatisfied with the analgesic effect and therefore the lead was moved to the upper part of the mandibular joint.
Once the researchers found a satisfactory analgesic effect, pain in the temporal and occipital region was significantly relieved. The patient experienced an improvement in quality of life and decided to undergo an implantation, which continued to be effective in the 2-year follow-up without any adverse events.
“Perhaps one of the most important reasons for successful PNFS treatment for CM, in this case, is because of the patient’s sufficient trust and active compliance during the treatment period. Regards the underlying mechanism, it may be that the relatively thin muscle fibers in the temporal to anterior auricular area made it easier for the electrode to stimulate the nerve branches in the superficial fascia,” the authors wrote.
The researchers suggested that the case report results could be used in the future for developing a novel approach of PNFS application.
“The application of PNFS is very extensive. It is a choice for intractable CM characterized by temporal pain that can achieve ideal clinical effects and is still safe,” noted the authors. “However, the current circumstances call for advanced related mechanisms study, standardized operation guides, and large sample [randomized controlled trials] to promote the application of PNFS.”
Li Y, Mao P, Zhu Q, et al. Peripheral nerve field stimulation to the preauricular area for intractable chronic migraine: a case report [published online May 24, 2019]. Journal of Pain Research. doi: 10.2147/JPR.S196214.