1. 2007;10;453-460Using Peripheral Stimulation to Reduce the Pain of C2-Mediated Occipital Headaches: A Preliminary Report
   Prospective Case Series
   Eugene A. Melvin, Jr., MD, F. Richard Jordan, MD, Richard L. Weiner, MD, and David Primm, MA.

Background: Peripheral nerve stimulation (PNS) is an accepted treatment for neuropathic pain. Recent studies have focused on its potential for relieving headache pain. 

Objectives: To investigate the effectiveness of PNS in reducing occipital headache pain. 

Design: A prospective, 12-week pilot study involving 11 patients evaluated before and after implantation of PNS systems to treat C2-mediated occipital headaches.   

Methods: Prior to and at 4 and 12 weeks after implantation, patients completed the Short-Form McGill Pain Questionnaire (SF-MPQ), Visual Analog Scale (VAS), and Present Pain Index (PPI). Patients also answered questionnaires and kept diaries to record stimulator use, medication consumption, and numbers of headaches.  

Results: A comparison of pre- and post-implantation evaluations showed statistically significant declines in scores on the SF-MPQ (64%; p = 0.0013), VAS (67%; p < 0.0001), and PPI (68%; p = 0.0009). Most patients (91% and 64% respectively) reported reductions in medication use and numbers of headaches. Patients also reported a reduction in headache symptoms and the impact of headaches on activities. Two adverse events were encountered, one due to a loose connection and, the other caused by lead migration.  

Conclusions: PNS reduced headache pain, headache frequency and medication use.