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Implant under scalp zaps away headaches
Associated Press
Feb. 17, 2003 01:20 PM

WASHINGTON - Teresa Lamesch endured a constant, incapacitating
headache for almost two years. The slight touch of wind blowing
against her forehead caused shocking jolts of pain. Bright sunlight
or loud noises could make her retch.

Heavy-duty narcotics and every other treatment failed to help.

Then Dr. Sandeep Amin tried a last-ditch experiment. He hooked a tiny
electrode to a needle and tunneled it under the skin by Lamesch's
left eye, stopping atop the nerve responsible for her pain. Powered
by a battery implanted near her collarbone, the device continually
zaps that nerve with electric pulses - blocking the Illinois woman's
pain.

"The minute he put it in, the pain was gone," says a grateful Lamesch.

An estimated 20 million Americans suffer severe headaches, and as
many as 10 percent of them have intractable head or facial pain.
Treatment after treatment fails. Some are true migraines, which stem
from inside the brain, but others - mistakenly called migraines -
result from damaged nerves along the face or scalp.

Now a few doctors are exploring how well nerve stimulators implanted
in different spots along the head could rid some of that crippling,
nerve-caused pain.

People feel pain when nerve cells pass signals from one to another
until the "I'm hurting" message reaches the brain.

Doctors have long implanted electrodes along the spinal cord to block
certain kinds of pain from the neck down by interrupting those
signals. But the stimulator had to be placed above the pain site - so
blocking pain in the back, legs or arms was doable, but not in the
head.

Then came the discovery that stimulating head and facial nerves at
skin-deep levels, not just directly against the spinal cord, could
work. First doctors targeted the occipital nerve to alleviate
whiplash-like pain or back-of-the-head headaches.

Now they're starting to target frontal headaches and facial pain, at
the supraorbital nerve just above the eye.

It sounds logical, but "it really was surprising" to headache
specialists that this new use of the implants seems to work well,
said Dr. Robert Levy, a neurosurgeon at Northwestern Memorial
Hospital who has implanted stimulators in the foreheads of four
people so far. The first two he treated have reached the two-year
mark pain free.

Nerve stimulation "has done wonders for this kind of a headache,"
agrees Amin, an anesthesiologist and pain specialist at Chicago's
Rush-Presbyterian-St. Luke's Medical Center, who implanted Lamesch
and another patient who suffered unrelieved headaches after brain
surgery.

It's simple to implant. A battery lies under the skin by the
collarbone, and a small wire runs up the neck and into the scalp. Two
implants are needed if pain is on both sides of the head.

A magnet turns the electric current on or off. Turned off, pain
resumes - but the implant is vulnerable to security devices like
those in airports, and must be switched off until patients pass by.

Nerve stimulation for headaches is still highly experimental. But a
handful of doctors have asked stimulator maker Medtronic Inc. to fund
studies to prove how well it works for different kinds of head pain.
Medtronic is considering a study, first, of occipital nerve pain.

A $5,000 to $10,000 implant sounds extreme for headaches. But these
are extreme cases: "I see patients who are significantly debilitated,
on dozens of medications, with overwhelming medical bills," Levy says.

Levy and Amin doubt nerve stimulation would help true migraines.
Instead, they hope to help people with the nerve-caused head or
facial pain, whose options now range from narcotic painkillers -
including implanted morphine pumps - to nerve-blocking injections
into the spinal cord. Some even undergo attempts to surgically
destroy the affected nerve.

Some, like Lamesch, fail all those options.

"I had stopped living," says the Wheaton, Ill., woman, who suffered
pain in her legs and head after a tricky knee operation. A spinal
cord stimulator stopped the leg pain so Amin finally adapted another
one for her forehead. Now, she says, "I am bionic. ... I'm getting
back on track."

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EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for
The Associated Press in Washington.