title: Long-Term Clinical Outcome of Peripheral Nerve Stimulation for Chronic Headache and Complication Prevention.
abstract: BACKGROUND
  Subcutaneous peripheral nerve stimulation (PNS) has emerged as a useful tool in the treatment of intractable headaches. However, complications such as skin erosion, infection and lead migration have adversely affected clinical outcome, and occasionally led to treatment cessation.
  
  
  OBJECTIVE
  Here we report the results of peripheral nerve stimulator implantation performed on 24 patients with various chronic headaches at our center over a period of 9 years. We describe the complications of the procedure and their prevention with a modified surgical technique.
  
  
  METHODS
  We searched our database for patients with chronic refractory headaches who had undergone PNS. Patients were assessed before being considered for PNS, and their pain characteristics were reviewed. Following a successful trial, patients were implanted with a permanent peripheral nerve stimulator. Selection of target nerves was based on headache diagnosis and head pain characteristics. Patients were followed for an average of 4.9 years. Headache characteristics before and after treatment were compared.
  
  
  RESULTS
  Twenty four patients were included in the study. All patients reported on improvement in head pain intensity, duration and frequency three months after permanent device implantation Mean total pain index (TPI) decreased significantly, from 516 ± 131 before the procedure to 74.8 ± 61.6 at the last follow up (P < 0.00001). There were no acute post-operative infections. Three patients had their stimulator removed. The self-rated treatment satisfaction was excellent in 54% of the patients, very good or good in 42%, and fair in 4%.
  
  
  CONCLUSIONS
  Our results support the use of PNS in some patients with refractory chronic headaches. Appropriate surgical planning and technique are important to achieve good clinical outcome and to minimize complications.
authors.affiliation: Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Linqiu
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Doylestown Hospital, Doylestown, PA, USA.
authors.forename: Avi
authors.initials: A
authors.lastname: Ashkenazi
authors.affiliation: Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Mercy Fitzgerald Hospital, Mercy Health System, Darby, PA, USA.
authors.forename: Na
authors.initials: N
authors.lastname: Jen
authors.affiliation: The Center for Pain Relief, Charleston, WV, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.affiliation: Jefferson Medical School, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhou
keywords: Auriculotemporal Nerve; Complication; Cranial Nerves; Headache; Occipital Nerve; Peripheral Nerve Stimulation; Supraorbital Nerve