Abstract

RODRIGO, M. D. et al. Cervicogenic headache: Treatment with peripheral C1-C2-C3 subcutaneous electrostimulation. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.6, pp.333-339. ISSN 1134-8046.

Introduction: We present seven patients with long-term, persistent, severe and non-controlled cervicogenic pain (C1-C2-C3) of diverse etiologies and refractory to other therapeutic options, that were treated with occipital peripheral extramedullary electrostimulation (C1-C2-C3) through surgical implantation of a uni- or bilateral cervico-occipital electrode. Material and method: Seven female patients with an average age of 50.5 years had the following diagnoses: cervicogenic headache (transformed migraine) in 3 patients; complex regional pain syndrome in 2 patients, one of them being a type 2 with cervical location secondary to syringomyelia C2-D1 + Arnold Chiari malformation + surgery and the other one with hemiface/neck/occipital location and left EESS secondary to carotid surgery; left postherpetic neuralgia at C1-C2-C3 in 1 patient and cervicogenic headache secondary to osteoarthritis in 1 patient. Results: Satisfactory analgesic result was provided in all the cases. In most patients, continuous pain disappeared and the number and severity of crises decreased. Physical activity returned to normal levels and three patients returned to work. Night rest had been poor in all of them, but returned to normal. Drug therapy was discontinued in two patients and significantly reduced in the remainder. Mean follow-up time was 16 months, with a maximum of 33 in the first case. Electrode displacement was a complication in two cases, one after 7 days of the final implant and the other after one year. Discussion: Neuromodulation mediated by invasive electrostimulation has shown its therapeutic use over the past years in patients with refractory and nontratable neuropathic pain. Recent advances in neurostimulation have provided new therapeutic options with the implantation of extramedullary electrodes for the stimulation of peripheral nerves. Conclusions: In all of our patients, pain location showed preferably a metameric distribution C1, C2 and C3. In all cases, occipital stimulation provided a very satisfactory or good result that was maintained over time, with relief of continuous pain, decreased frequency and severity of pain crises, functional improvement of night rest, normalization of daily life activity and reduced need of pharmacological treatment.

Keywords : Peripheral occipital invasive electrostimulation; Cervicogenic headache; Transformed migraine.

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