Migraine is a highly disabling disease, with high financial and social impact (1). Migraine treatment can be both acute and preventive, several pharmacological classes can be effective, as also may non-pharmacological therapies (2,3). Nerve blocks, botulinum toxin type A, and neuromodulation may play an important role in the management of migraine (4).
A number of studies have come to light, showing that external stimulation of certain parts of the head, may contribute to the management of pain (5,6,7,8) Thermal microcautery have been used for the treatment of pain disorders, but limited information is available about its role in migraine treatment (9). We aimed in this study to present our experience in a case series of patients treated with thermal microcautery.
Patients were selected from the Neurological Headache outpatient clinic of G.N.A. ‘’G. Gennimatas’’, from November 2017 up to March 2019.
Inclusion / exclusion criteria
The inclusion criteria were as follows –
- Diagnosis of chronic migraine with or without aura and/or Medication Overuse Headache (MOH).
- The failure of at least one preventive
- Patients were not allowed to undergo Botox injections (10,11) Acupuncture and Transcutaneous Electrical Nerve Stimulation for at least 3
In this technique we applied instantly intense heat (600° C) to an area of localized pain (2) identified by clinical examination before the procedure. The heat was applied by a low temperature cautery disposable fine tip pen, Fiab Disposable electrocautery pensF7255 (28 mm) which is routinely used in dermatology for microsurgery.
Thermal microcautery was performed on bilateral cervical, occipital, supraorbital and temporal areas, (12) depending on what patients referred to as the most painful points during the attack of migraine and also between acute attacks.
Post procedure a cooling cream was applied (1gr., Pistacia Lentiscus, Shorea robusta)
It was planned that each patient would undergo 4 sessions, every 7-10 days. Each patient had a recording of the frequency, duration, intensity of episodes of headache, medication use and response. We recorded the VAS pain score in each session.
The protocol of the study had been submitted to the Hospital’s Ethical Committee and had been approved. All patients were fully informed about the aim of the study, the procedure and the complications and had filled out a consent form.