title: Peripheral neurostimulation in the management of cervicogenic headache: four case reports.
abstract: Introduction.  Neuromodulation, mediated by invasive electric stimulation, has been shown to be effective when applied to patients with refractory and intractable neuropathic pain. Recent advances in neurostimulation have broadened the therapeutic uses of this therapy, with the placement of extraspinal electrodes for peripheral nerve stimulation. Methods.  Four patients with long-evolving, persistent, severe, uncontrolled, and localized pain in the occipital region, in whom other management options had been tried and failed, were treated with a peripheral, occipital, extraspinal electric stimulation (C1-C2-C3). We present, as case reports, the results of this intervention in these four patients. Results.  In all cases, stimulation of the occipital region yielded good or very good global results. In all patients, continuous pain disappeared, the frequency and severity of the episodic pain decreased, function improved, and restful sleep improved. As a result of stimulation we were either able to reduce or discontinue medication usage in all of our patients.
authors.affiliation: Pain Unit, Anesthesia Department and              Angiology and Vascular Surgery Department, Hospital Clínico Universitario "Lozano Blesa", Zaragoza; and              Anesthesia Department, Hospital Royo Villanova, Zaragoza, Spain.
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Rodrigo-Royo
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Azcona
authors.forename: Jose
authors.initials: J
authors.lastname: Quero
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Lorente
authors.forename: Pilar
authors.initials: P
authors.lastname: Acín
authors.forename: Javier
authors.initials: J
authors.lastname: Azcona