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  • Neuromodulation of the Great Auricular Nerve

    Final Number:

    Foad Elahi MD; Chandan G. Reddy MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Headaches are often difficult to treat, particularly since significant symptomatic overlap amongst primary headache syndromes makes establishment of an accurate diagnosis challenging. Electrical neuromodulation of the C2-C3 branches within the great auricular nerve (GAN) distribution was proposed as a potential long-term treatment for chronic, intractable headaches

    Methods: In this case series we will discuss clinical presentation of patients having several prior headache attacks successfully aborted with ultrasound-guided GAN blocks underwent permanent peripheral neurostimulator implantation.

    Results: At 6-month follow-up post permanent neurostimulator implantation, the patients reported significant, sustained pain alleviation, with daily baseline pain scores averaging one to two on the NRS scale. Overall patients satisfaction were 95%.

    Conclusions: A highly selective group of migraine patients may potentially be appropriate candidates for electrical neuromodulation treatment.

    Patient Care: In recent years, neuromodulation has experienced a renaissance as a treatment option for a variety of chronic pain conditions. Great auricular nerve neuromodulation offers a unique opportunity to better understand and reduce the disability of a proportion of patients with medically intractable, primary headache disorders. This case series report potentially opens yet another treatment option in the armamentarium of interventional pain medicine practitioners against chronic, primary headache.

    Learning Objectives: There is growing evidence that the upper cervical nerves may play a significant role in migraine and cluster headache, and that these nerves may be important therapeutic targets for these and other primary headache disorders

    References: 1. Saper JR, Dodick DW, Silberstein SD, McCarville S, Sun M, Goadsby PJ. Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalgia 2011;31(3):271-85. 2. Rodgrigo-Royo, Azcona JM, Quero J, Lorente MC, Acin P, Azcona J. Peripheral Neurostimulation in the Management of Cervicogenic Headache: Four Case Reports. Neuromodulation 2005,8:241-248 3. Melvin EA, Jordan FR, Weiner RL, Prim D: Using peripheral stimulation to reduce pain of C2-mediated occipital headaches: a preliminary report. Pain Physician 2007,27:153-157 4. Goadsby JP, Bartsch T, Dodcik D. OccipitalNerve Stimulation for Headache: Mechanisms and Efficacy. Headache. 2008;48:313-318 5. Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitiability of dura afferent input. Brain 2002; 125:1496-509

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