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Rate ePoster

Pain and Spine Medicine

60-day Peripheral Nerve Stimulation for the Treatment of Cervicogenic Headache and Occipital Neuralgia: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater

    Poster Presenter(s)

  • Emily Deschler, BS

    Medical Student
    Sidney Kimmel Medical College at Thomas Jefferson University
    Allentown, Pennsylvania

    • Co-Author(s)

  • Nam Vo, DO

    Chief Resident Physician, PGY-4
    University of Arkansas for Medical Sciences PM&R Program
    Little Rock, Arkansas

  • JK

    Jane Keilitz, PA-C

    Physician Assistant
    Atrium Health Wake Forest Baptist
    High Point, North Carolina

  • DB

    Daniel Bintrim, MD

    Assistant Professor
    Wake Forest University School of Medicine
    Winston Salem, North Carolina

  • JP

    Janus Patel, MD, MPH

    Assistant Professor
    Wake Forest School of Medicine of Wake Forest Baptist Medical Center
    Winston Salem, North Carolina

  • EG

    Enrique Galang, MD

    Assistant Professor
    Wake Forest University School of Medicine
    Winston-Salem, North Carolina

Disclosure(s):
Emily Deschler, BS: No financial relationships to disclose
Nam Vo, DO: No financial relationships to disclose
Daniel Bintrim, MD: No financial relationships to disclose
Case Diagnosis: A patient with cervicogenic headache and occipital neuralgia achieved significant pain relief following 60-day peripheral nerve stimulation (PNS).

Case Description or Program Description: The patient has a history of chronic headaches consistent with occipital neuralgia and cervicogenic headache. Conservative treatments, including gabapentin, opioids, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and topical pain medications, failed to provide adequate relief. Occipital nerve blocks provided excellent but short-term relief, lasting only 1 month. Subsequent diagnostic nerve blocks of the third occipital nerve, C3 medial branch, and C4 medial branch, followed by radiofrequency nerve ablation, also resulted in excellent but temporary relief. Given the patient's medical history, physical exam findings, and imaging results, a shared decision was made to proceed with a 60-day PNS implantation targeting the third occipital nerve and C3 medial branch nerve. The peripheral nerve implantation was performed fluoroscopically, placing two leads to target these nerves.

Setting: Academic tertiary interventional pain clinic

Assessment/Results: The patient endorsed 90% reduction in pain at 30-days post procedure and at 60-days post-procedure prior to lead pull. The patient also demonstrated improvements in sleep and activities of daily living. Additional follow-up results will be discussed.

Discussion (relevance): This case illustrates the effective application of a 60-day PNS implant, which resulted in pain relief and functional improvement for the treatment of occipital neuralgia and chronic cervicogenic headache. Chronic headaches are the second most prevalent disease and the second leading cause of years lived with disability globally. Occipital neuralgia can coexist with other more prevalent headache etiologies.

Conclusions: This case highlights the challenges of managing patients with overlapping headache disorders. PNS targeting the third occipital nerve and cervical medial branches is a promising treatment for chronic refractory headaches, including occipital neuralgia and cervicogenic headache.