Abstract Chronic migraine is a disabling neurological condition with a subset of patients remaining refractory to pharmacological therapy. Occipital nerve stimulation (ONS) has emerged as a neuromodulatory option in such cases. This case report describes a 38-year-old woman with a 2.5-year history of severe, refractory chronic migraine that had not responded adequately to multiple preventive and abortive medications or botulinum toxin A. She underwent bilateral ONS with implantation of a nonrechargeable implantable pulse generator and experienced immediate, sustained improvement, with pain falling from the Numeric Rating Scale of 10/10–0/10 and disability scores dropping markedly. Benefit was maintained for nearly 5 years with periodic reprogramming, and when symptoms recurred because of battery depletion, replacement with a rechargeable system restored significant pain relief. The report concludes that ONS can provide durable benefit in carefully selected patients with refractory chronic migraine, provided that long-term follow-up and hardware management are maintained.
Ramsay Hunt syndrome (RHS) is a varicella zoster virus infection of the geniculate ganglion characterized by vesicular rash, ear pain, and ipsilateral facial nerve palsy. Management includes antivirals, corticosteroids, and anticonvulsants; In addition, sympathetic neural blockade via stellate ganglion block (SGB) is used to relieve symptoms and prevent facial nerve damage. We report a case of a 70-year-old man diagnosed with RHS who presented with right ear pain, fluid-filled vesicles in the ear and mandibular division (V3) of the trigeminal nerve, hearing loss, and facial weakness on the right side. He was treated with anticonvulsants, opioids, and topical agents for pain relief. Since there was no response to pharmacotherapy after 2 weeks, SGB was performed on the right side under ultrasound guidance. At 3 months follow-up, the patient had significant improvement in pain with complete recovery of facial weakness and hearing loss.
Uterine artery embolisation (UAE) is a well-established minimally invasive treatment for symptomatic uterine fibroids, but it is frequently associated with significant periprocedural pain due to ischemia of uterine tissue. Conventional analgesia using opioids and nonsteroidal anti-inflammatory drugs may be insufficient or associated with systemic side effects. Superior hypogastric plexus block (SHPB) has emerged as an effective preoperative intervention to improve analgesia in this setting. This case report discusses a 22-year-old female posted for UAE, given a trial of SHPB prior to the procedure. SHPB decreases the need for analgesics and less bleeding during the procedure.
Supraorbital neuralgia, according to the International Classification of Headache Disorders, is an uncommon craniofacial pain syndrome marked by paroxysmal or persistent pain localized to the supraorbital notch and medial forehead in the distribution of the supraorbital nerve, associated with tenderness over the supraorbital notch and relief with nerve blockade (Headache Classification Committee of the International Headache Society, 2004). Often misdiagnosed as migraines, supraorbital neuralgia requires a high index of suspicion for accurate diagnosis (Evans and Pareja, 2009). We present a case of a 60-year-old female with chronic supraorbital pain initially misdiagnosed as migraine, successfully treated with ultrasound-guided radiofrequency ablation (RFA) of the supraorbital nerve. This report emphasizes the significance of recognizing supraorbital neuralgia and highlights RFA as a safe and effective treatment option (Ren et al ., 2020; Lee et al ., 2014).
