Mrs. J is a 47-year-old female who presented to our clinic in 2001 with a two-year history of intractable headaches. She states that she suffered a rear end collision in 1999 leading to a whiplash injury and a concussion. She states that she did not lose consciousness at the time of the accident but was "dazed" for several hours. For several weeks following the accident she suffered sensitivity to light as well as some minor anterograde amnesia.
At the time of presentation to Georgia Pain Physicians, her dominant complaint was daily, severe headaches. She stated that she had already seen three neurologists, had three brain MRI's, two EEG's, and had been on a myriad of medications for migraines, none of which helped. She had also been to another pain clinic where she had been treated with cervical epidural cortisone injections, facet joint injections, trigger point injections and physical therapy.
When she presented to our clinic, X-rays were obtained which demonstrated minor (nonsurgical) instability in the upper cervical spine and pain to palpation at the point where the greater occipital nerve crossed the nuchal ridge. This nerve was blocked with local anesthetic during the initial visit, which gave her 70% pain relief for the first time since the accident in 1999. She returned to clinic in one week reporting that the pain relief had lasted for 2 days at which point it returned. This injection was repeated upon at the first follow up visit with local anesthetic and cortisone. This time the pain relief lasted one week but returned to its previous baseline. Upon return to clinic, a TENS unit was prescribed which was well tolerated but failed to relieve her pain. As a result, a subcutaneous spinal cord stimulator was pursued.
Spinal cord stimulation (SCS) in the United States is usually used for chronic lumbar radiculopathy or complex regional pain syndrome (CRPS, RSD). It has only recently been used for the treatment of occipital headaches responsive to occipital nerve blocks. To perform this technique, an epidural needle is placed in the soft tissues extending from the midline towards the mastoid process and a spinal cord stimulating lead is placed in the needle. Care is taken to thread the needle superficial to the greater occipital nerve so that when the needle is removed and the lead is left in place it lies superficial to the nerve. The nerves may then be stimulated which places paresthesia in the occipital region. This treatment method is performed as a temporary test to evaluate its effectiveness at blocking the transmission of pain signals to the brain and then is implanted as a permanent device if the test proves successful.
Mrs. J underwent an 8-day test in May 2001 and received 90% reduction in pain. She was permanently implanted bilaterally in June 2001. As of the time of this writing, she has been followed every three months for 2 ½ years. She has maintained 80% reduction in pain and continues to use her device daily. She is working full time and is taking no habit-forming medication. She is extremely pleased with her implant.