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

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