FAQs on Spinal Cord Stimulation for Migraine Pain

Spinal cord stimulation has emerged as the most potent neuromodulation therapy to treat migraine pain. According to the International Headache Society, 80% of patients with chronic migraine response to SCS therapy while it offers 80% to 100% improvement in managing migraine pain and related disability.

What is migraine pain?

Migraine is a powerful headache that accompanies pulsating pain in the head and often with vomiting, fatigue, and numbness. Patients experience pain on one or both sides of the head.

Migraine is often preceded by sensitivity to light, sound, and smells and physical activity may increase the headache. It may last between 2 hours to 3 days.

How common is the occurrence of migraine?

About 28 million Americans suffer from migraine pain and 15% to 20% of them do not respond to ant medical treatment. In fact, there is no conventional treatment to eliminate the pulsating headache. It can only be managed.

Women are at 3-time more risk to have migraine pain than men. Family history plays an important role in causing migraine headache.

What are symptoms of migraine pain?

  • 1. Moderate to severe headache
  • 2. Pulsating pain
  • 3. ightheadedness
  • 4. Nausea and vomiting
  • 5. Fatigue
  • 6. Irritation
  • 7. Sensitivity to s]light and sound

Migraine may also lead to neurological disorders, confusion, vision disorder, acute discomfort, and disability.

How effective is spinal cord stimulation in treating migraine pain?

Spinal cord stimulation is the best possible method to manage migraine pain in patients unresponsive to any other treatment method. The SCS therapy is more than 90% effective in controlling neuropathic pain similar to migraine.

A 2011 study reported 31% improvement in migraine patients using spinal cord stimulation at 12 weeks. About 88% found the therapy significantly beneficial. After a year, 65% experienced excellent pain relief, 67% were satisfied, and 68% had big improvement in quality of life.

Another 2015 study attested 60% overall pain reduction after 15 months. While 71% of the patients have more than 50% pain relief while 37.5% did not require pain medication after spinal cord stimulator implant.

What is a spinal cord stimulator?

A spinal cord stimulator is electrical device similar to the size of a stopwatch. It was approved for pain management in 1984. The device is implanted in the body. It sets in motion a process called neuromodulation to stimulate nerves and interrupt pain sensation transmission to ensure pain relief.

How does a spinal cord stimulator treat migraine pain?

Spinal cord stimulator delivers electrical pulses to the spinal column. These signals alter the function of nerves and disrupt their ability to carry migraine pain messages to the brain. This leads to excellent migraine pain relief.

Am I a candidate for spinal cord stimulation?

You can consider spinal cord stimulation if

  • you have persistent migraine attacks for a long time
  • you have no respite from migraine pain when using convention treatment
  • you are physically fit to have spinal cord stimulator implant

Who should not have this procedure?

Migraine patients usingblood thinners and with active infections and serious neurological deficit are not considered for spinal cord stimulation therapy.

Does spinal cord stimulator block all types of sensations?

No, spinal cord stimulation does not interrupt all types of sensation. The device only targets the firing pattern of Aδ and C nerve fibers responsible for carrying pain signal to the brain and inhibits their excitability. This prevents painful impulses to a great extent. 

Will spinal cord stimulation eliminate the source of migrainepain?

No, spinal cord stimulation is a pain interruption procedure. It disrupts migraine pain signals and prevents them from reaching to the brain. However, it does not eliminate the source of migraine pain.

How will I know if spinal cord stimulation is beneficial for my migraine pain?

The spinal cord implant is a two-stage process, first being a screening test to check the benefits of SCS therapy and second is the permanent implant.

The trial stage involves placing a catheter connected to the device wrapped around the abdomen into the spinal area. It delivers electrical impulses to ensure pain signal disruption. If the trial provides at least 51% relief from migraine pain over a period of days, the SCS therapy is considered beneficial for the patient in the long run. Afterwards, the permanent implant is performed.

How long does the implant procedure take?

Spinal cord stimulator implant takes about 2 to 3 hours. It is performed as an outpatient procedure.

Will the spinal cord implant procedure hurt?

No, the implant is performed using general anesthesia. At most, patients feel mild discomfort and soreness. It is easy to tolerate.

What should I expect after the implant?

You may feel soreness at the incision sites for a few days. There may be tingling sensation when the device starts. You may also start experiencing relief from migraine pain as soon as the implant is performed. 

What should I do after the procedure?

Keep the incisions dry and clean. Avoid driving for 4 weeks and all types of rigorous activities for 6 weeks. You should not bend or twist your body for the first few weeks. Rest for a week is advisable. Never drive or operate heavy equipment while the device is turned on.  

What are the things I can’t do after spinal cord implant?

Those using spinal cord stimulation to manage migraine pain are not suitable to undergo “MRI tests, therapeutic ultrasound diathermy, and microwave or short-wave diathermy.” You can have both the spinal cord stimulator and pacemaker in your body subject to certain implant guidelines.

Those with spinal cord stimulators implanted in their body need to carry certificates of the same to avoid inconvenience at airports. Metal detectors may recognize and beep, as they go through. 

How long does spinal cord stimulator last?

Spinal cord stimulator implant is a life-long process. You need to replace its batteries in every 5 to 110 years depending on the usage.

What does spinal cord stimulation feel like? 

Spinal cord stimulation to manage migraine pain does not create any noise. At best, patients feel a sensation when the device is turned on.

How big is a spinal cord stimulator? 

The device is about the size of a stopwatch.

How do I control the spinal cord stimulation for migraine? 

A handheld remote programmer helps control, program, and adjust the device to deliver the preferred level of sensation.

Can the spinal cord stimulator be removed? 

Yes, the stimulator can be removed.

Does spinal cord stimulation completely eradicatemigraine pain? 

Spinal cord stimulation leads to significant and sustained reduction in migraine. It does not cure the pain, but helps manage it. A 2011 study reported 31% improvement in migraine patients using spinal cord stimulation at 12 weeks. About 88% found the therapy significantly beneficial. After a year, 65% experienced excellent pain relief, 67% were satisfied, and 68% had big improvement in quality of life.

Is the implant covered by insurance?

Subject to your policy conditions, spinal cord stimulator implant is covered by insurance companies.

What are the benefits of spinal cord stimulation for migraine patients? 

  • 1. Significant, sustained chronic pain reduction
  • 2. Fewer migraine attacks
  • 3. Improved quality of life
  • 4. Improved ability to function
  • 5. No need of painkillers
  • 6. Safer pain treatment
  • 7. Adjustable pain treatment
  • 8. Reversible treatment, can you it as per your need

Do I need to change spinal cord stimulator implant after some years?

No, once implanted, the device lasts for more than 20 years. Only thing you need to change after a few years is batteries. You can go for a device with internal or external batteries.

How often is the battery changed?

Spinal cord stimulator batteries last between 5 to 10 years.

What are risks and side effects associated with spinal cord stimulator implant?

  • 1. No major risks or side effects
  • 2. Surgical complications, epidural bleeding, nerve damage when not performed by an expert
  • 3. Scar tissue formation
  • 4. Spinal headache due to fluid leakage in rare cases
  • 5. Lead breaking and disposition leading to revision surgery

References

Neurostimulation Gets CE Mark Approval for Chronic Migraine. Medscape. Sep 07, 2011.

De Agostino R, Federspiel B, Cesnulis E. High-cervical spinal cord stimulation for medically intractable chronic migraine. Neuromodulation. 2015 Jun;18(4):289-96

Arcioni R, Palmisani S, Mercieri M, et al. Cervical 10 kHz spinal cord stimulation in the management of chronic, medically refractory migraine: A prospective, open-label, exploratory study. Eur J Pain. 2016 Jan;20(1):70-8.

Freeman J, Trentman T. Clinical utility of implantable neurostimulation devices in the treatment of chronic migraine. Med Devices (Auckl). 2013; 6: 195–201.

Ellens DJ, Levy RM. Peripheral neuromodulation for migraine headache. ProgNeurol Surg. 2011; 24:109-17. Epub 2011 Mar 21.

Rush University Medical Center. “Spinal Cord Stimulators Tested As Treatment For Patients With Migraine Headaches.” ScienceDaily. ScienceDaily, 29 September 2006.

Reed KL, Black SB, Banta CJ, et al. Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: initial experience. Cephalalgia. 2010 Mar;30(3):260-71.