Ultrasound imaging and occipital nerve stimulation
Section snippets
INTRODUCTION
Chronic daily headache (CDH) syndromes represent a major health issue worldwide in terms of lost workdays and revenue (1., 2., 3.). Diagnoses include migraine, atypical migraine, cluster, transformed migraine, and cervicogenic headaches, as well as occipital and facial hemicranias, or any combination of the above. Many of these patients are totally disabled, having failed conservative and pharmacologic treatments (4,5).
Occipital neuralgia (ON), however, is described by the National Institute of
METHODS
A total of six patients, diagnosed with refractory CDH and ON, were referred from the neurology service. After failing extensive medical management (biofeedback, physical therapy, massage, acupuncture, narcotics, NSAID’s, tricycle antidepressants, anticonvulsants, tryptans, beta blockers), they were diagnosed as potential candidates for ONS after positive anesthetic phase response to occipital nerve blockade. Subsequently, all underwent successful percutaneous trials of bilateral octopolar
DISCUSSION
Ultrasound guidance in regional anesthesia and pain medicine was first described in 1978 (27). A Doppler ultrasound blood flow detector was used to localize the third division of the subclavian artery, rendering the supraclavicular approach to the brachial plexus safer and highly successful. The ultrasound-guided applications have emerged not only as an alternative to regional anesthesia neurostimulating techniques (21,22) but also as an alternative to radiation emitting fluoroscopic techniques
CONCLUSION
In this case series, ultrasonography provided real-time, safe, and reliable placement of ONS electrodes. It also allowed identification of nervous and vascular structures unable to be seen with fluoroscopy. The portable nature of modern ultrasound machines, together with an ever-improving pixelation of the Doppler color flow images/real-time measurements, and a lack of radiation exposure make this technology an attractive emerging modality in the field of neuromodulation. Future prospective
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