title: The treatment of medically intractable trigeminal autonomic cephalalgia with supraorbital/supratrochlear stimulation: a retrospective case series.
abstract: BACKGROUND
  This is a retrospective case series of five patients with intractable trigeminal autonomic cephalalgia (TAC) who were implanted with a supraorbital/supratrochlear neuromodulation system.
  
  
  OBJECTIVE
  The aim of this Institutional Review Board-approved study was to investigate the percentage of pain relief, treatment response, pain level, work status, medication intake, implantation technique, lead placement, programming information, and device use.
  
  
  RESULTS
  Trial stimulation led to implantation of all five patients. All patients reported improvement in their functional status in regard to activities of daily living. The device was revised in two patients due to skin erosion. It was later reimplanted in both patients due to worsening of symptoms, again with good pain relief. The device was explanted in two other patients because of the need to perform a magnetic resonance imaging or implant an automatic implantable cardioverter defibrillator. The follow-up of the patients ranged between 18 months and 36 months, with a mean of 25.2 months. There was no change in work status. Following the implant, the Visual Analog Scale score was reduced to a mean of 1.6 from an initial mean score of 8.9. Three patients were completely weaned off opioid medications, while two patients continued to take opioid at a lower dosage. All patients experienced a decrease of the adjuvant neuropathic drugs.
  
  
  CONCLUSIONS
  Supraorbital/supratrochlear nerve stimulation appears to be a promising modality for the treatment of patients with intractable TAC.
authors.affiliation: Pain and Wellness Center, Peabody, MA 01960, USA. jvaisman@painandwellnesscenter.com
authors.forename: Julien
authors.initials: J
authors.lastname: Vaisman
authors.forename: Herbert
authors.initials: H
authors.lastname: Markley
authors.forename: Joe
authors.initials: J
authors.lastname: Ordia
authors.forename: Timothy
authors.initials: T
authors.lastname: Deer
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000502:physiology; D059408:Pain Management; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D019919:Prosthesis Implantation / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D051303:Trigeminal Autonomic Cephalalgias / Q000628:therapy*; D014321:Trochlear Nerve / Q000502:physiology
chemical_list: D000701:Analgesics, Opioid