Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Atypical facial pain and chronic headache conditions may involve the dysfunction of one or more cranial and/or spinal nerves and dramatically impede quality of life. Pain management for these cases may be complicated, especially when medication options are limited. Neuromodulation may be considered for intractable cases. Here, we present our experience with a novel application of neuromodulation that may harness a common mechanism for the treatment of cranial/facial pain.
CASE REPORT: Case 1 presented with alveolar neuralgia triggered by eating or drinking and causing headaches in the upper cervical and facial area. Case 2 presented with chronic daily headaches. Both received spinal cord stimulation (SCS) implants with leads at C3-C4 using BurstDR stimulation. After several months of treatment, Case 1 was once again able to eat while nearly 100% pain free with complete cessation of pain medication. Case 2 reported that his headache frequency decreased to approximately twice per month, allowing a 90% decrease in pain medication and improvement in quality of life.
CONCLUSION: Reasons for excellent pain relief of alveolar neuralgia pain and chronic headache pain via burst SCS at C3-C4 could be the overlap of nerve systems and their convergence at the trigeminocervical complex in the cervical spine. This may explain the effectiveness of high cervical stimulation to treat facial and headache pain located outside of the typical boundaries of the recruited fibers.
Although a single-electrode array proved to be efficacious, using 2 electrode arrays improves the anatomic coverage of the painful areas and allows for greater optionality in electrode selections to avoid plasticity.
KEY WORDS: Burst, BurstDR, dorsal column stimulation, facial pain, headache, nerve pain, nerve stimulation, neuropathic pain, spinal cord stimulation