Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine.
BACKGROUND
Up to 5% of the general population suffers from transformed migraine. This study analyzes clinical responses of transformed migraine to cervical peripheral nerve stimulation.


METHODS
Headache frequency, severity, and disability (Migraine Disability Assessment [MIDAS] scores) were independently measured in an uncontrolled consecutive case series of 25 patients with transformed migraine implanted with C1 through C3 peripheral nerve stimulation. All patients met International Headache Society (IHS) criteria for episodic migraine, as well as suggested criteria for transformed migraine, and had been refractory to conventional treatment for at least 6 months. Responses to C1 through C3 peripheral nerve stimulation were recorded.


RESULTS
Prior to stimulation, all patients experienced severe disability (grade IV on the MIDAS) with 75.56 headache days (average severity, 9.32; average MIDAS score, 121) over a 3-month period. Following stimulation, 15 patients reported little or no disability (grade I), 1 reported mild disability (grade II), 4 reported moderate disability (grade III), and 5 continued with severe disability (grade IV), with 37.45 headache days (average severity, 5.72; average MIDAS score, 15). The average improvement in the MIDAS score was 88.7%, with all patients reporting their headaches well controlled after stimulation.


CONCLUSIONS
These results raise the possibility that C1 through C3 peripheral nerve stimulation can help improve transformed migraine symptoms and disability. A controlled study is required to confirm these results.
Popeney
Charles A
CA
Fort Bend Neurology, Suite 110, 2225 Williams Trace Boulevard, Sugarland, TX 77478, USA.
Aló
Kenneth M
KM
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D002574:Cervical Vertebrae; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000145:classification / Q000150:complications / Q000628:therapy*; D010148:Intractable Pain / Q000628:therapy*; D010525:Peripheral Nerves
D000700:Analgesics