Noninvasive neuromodulation of supraorbital and occipital nerves as an adjunct to management of chronic headache

Nazia Tauheed¹, Aftab Hussain¹, Hira Afzal¹, Lubna Zafar², Hammad Usmani¹

¹ Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
² Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Abstract

Background: Chronic daily headache (CDH) results in significant distress and a substantial impact on the quality of life. Due to its nature of refractoriness to conservative management, exploring other modalities seems worthwhile. Invasive nerve stimulation, though promising, has seen complication rates in plenty. The goal of the present study was to assess the efficacy of noninvasive neuromodulation of supraorbital and occipital nerves (SON and ON) using hybrid pulsed radiofrequency device (Stimpod NMS460) in patients of CDH.

Methods: Thirty patients suffering from CDH were enrolled in this randomized double‑blind sham‑controlled trial and randomly allocated to two groups of 15 patients each. SON and ON stimulations were given using the device Stimpod NMS460 thrice a week for 3 weeks. Follow‑up visits were scheduled at 6 and 12 weeks of therapy. Pain relief was measured using numerical rating scale score. The overall change in quality of life (measured by Short Form‑12 Health Survey) and associated complications were also noted.

Results: Successful stimulation (50% or greater decrease in pain intensity) was seen in 66.67% patients; inadequate response in 33.3% in the intervention group. The 50% responder rate in sham control group was 13.3%; remaining 86.6% showed an inadequate response. This response remained sustained up to 12 weeks of follow‑up. Similar changes were observed in the quality of life of patients. No adverse effect was documented during the study period.

Conclusion: Noninvasive neuromodulation may serve as a safer and cost‑effective treatment option in CDH refractory to conservative management.