Significant Pain Relief and Quality of Life Improvement in Refractory Chronic Migraine Patient Treated With High-Frequency Spinal Cord Stimulation

INTRODUCTION A significant number of chronic migraine patients fail conventional medical treatment, becoming highly disabled. High-Frequency 10 kHz Spinal Cord Stimulation (10kHz SCS) have been used as a physical therapy for refractory migraine in a limited number of patients, showing promising results1-4. We report the case study of a young patient with a long history of severe and invalidating migraine treated with cervical 10kHz SCS. METHODS The subject underwent a 2 weeks cervical HF10 SCS trial followed by a permanent system implant as subjective pain reduction was reported during the trial. Two leads were placed at the C1-C2 level. Stimulation parameters included 10-kHz frequency, 30-μs pulse width delivered via bipole, and amplitude range of 0.5 to 3.5 mA. Optimal bipole location and amplitude were adjusted per patient feedback. At permanent implantation, a second program was added for neck and shoulder pain and patient was instructed to activate it as needed. RESULTS The patient is a 43 years old woman with a familiarity for headache and chronic migraine since the age of 8. Migraine was diagnosed as without aura but episodes with aura were present as the condition progressed in recent years. The subject had undergone several multi pharmacological conventional treatments with limited relief, and Greater Occipital and Peripheral Occipital Nerve Block, Greater Occipital and Peripheral Bilateral Pulsed Radiofrequency with no benefit. At the time of SCS implantation, the patient was treated with monoclonal antibody galcanezumab, therapeutic cannabis, venlafaxine, pregabalin, delorazepam, estrogen-progestin, and ibuprofen. Pain manifested daily as a continuous pain, flaking frequently as invalidating events (up to 14 per month) with pulsing unilateral periorbital or occipital-nape pain associated with photophobia, phonophobia, nausea, vomit, tinnitus, and vertigo. After a month of neurostimulation with 10kHz SCS, the patient self-reports a 50% pain relief with no change in medication regime. The patient declares an improvement in quality of life and less time spent bed-ridden. While a continuous headache is still present, the intensity is reduced compared to pre-implantation. CONCLUSIONS Neurostimulation with cervical 10kHz SCS can be a safe and effective therapeutic option for chronic migraine refractory to conventional pharmacological and physical treatments.