138 Headache Medicine, v.8, n.4, p.138-139, Oct./Nov./Dec. 2017

Anything but a shocking solution – the effectiveness of

Cefaly® in non-migrainous headache

Uma solução chocante - a eficácia de Cefaly® em cefaleia não-migranosa

Pedro André Kowacs

1,2

, Paulo Sergio Faro Santos

, Elcio Juliato Piovesan

, Helio Afonso Ghizoni Teive

5,6

Neurologist, Coordinator of the Headache Outpatient Clinic and Medical Residency in Pain Medicine,

Neurology Division, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil

Head of the Neurology Division, Neurological Institute of Curitiba, Curitiba, Brazil

Neurologist, Head of Headache and Orofacial Pain Clinic, Neurology Division,

Neurological Institute of Curitiba, Curitiba, Brazil

Neurologist, Assistant Professor of Internal Medicine, Faculty of Medicine, Federal University of Paraná, Curitiba, Brazil

Neurologist, Associate Professor of Neurology, Faculty of Medicine, Federal University of Paraná, Curitiba, Brazil

Coordinator, Movement Disorders Outpatient Clinic, Neurology Division, Internal Medicine Department,

Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil

Kowacs PA, Faro Santos PS, Piovesan EJ, Teive HAG. Anything but a shocking solution - the effectiveness of Cefaly®

in non-migrainous headache. Headache Medicine. 2017;8(4):138-139

CASE REPORT

ABSTRACT

Background: The transcutaneous supraorbital nerve

stimulation with the Cefaly® device has demonstrated safety

and efficacy for the prevention of episodic migraine. However,

there isn't description of its efficacy in other headaches. Case

report: A 78-year-old man was seen because of a 55-year

history of daily headache. His medical history revealed

Parkinson's disease, dyslipidemia and mild cognitive

impairment. Physical examination revealed bradykynesia and

asymmetric resting tremor of both arms, the right more affected

than the left. There was mild pain on palpation of both upper

trapezius muscles adjacent to the occipital bone. Cervical spine

X-ray, CT and MRI: no findings. Various therapeutic approaches

were done, but without success, so it was decided to prescribe

Cefaly®. At his three-month follow-up, he reported an

improvement of about 80%. Conclusion: The case described

here shows that Cefaly® may be effective in headaches other

than migraine.

Keywords: Headache; Non-migrainous headache; Cefaly;

Transcutaneous supraorbital nerve stimulation

A 78-year-old man was seen because of a 55-year

history of daily headache with intense bilateral nuchal

pain, without autonomic symptoms, and that occurred from

the moment he awoke until the moment he fell asleep.

The headache would sometimes become worse when he

lay his head on the pillow to sleep at night. His medical

history revealed Parkinson's disease, dyslipidemia and mild

cognitive impairment. He regularly used levodopa/

benserazide 100/28.5 mg q.i.d., a rotigotine patch 4

mg/24hours o.d., donepezil 5 mg o.d., aspirin 100 mg

o.d., rosuvastatin 20 mg o.d., ezetimibe 10 mg o.d.,

lactulose 667 mg o.d. and esomeprazol 20 mg as needed.

Physical examination revealed bradykynesia and

asymmetric resting tremor of both arms, the right more

affected than the left. There was mild pain on palpation of

both upper trapezius muscles adjacent to the occipital

bone. Cervical spine X-ray, CT and MRI imaging failed to

clarify the nature of the pain, which was interpreted as

myofascial. According to the International Classification

of Headache Disorders, the diagnosis was cervicogenic

headache (code 11.2.1). Various therapeutic approaches,

such as simple or combined analgesics (acetaminophen),

NSAIDs, codein, tramadol and 5% lidocaine patch, failed

Headache Medicine, .8, n.4, p.138-139, Oct./Nov./Dec. 2017 139

ANYTHING BUT A SHOCKING SOLUTION – THE EFFECTIVENESS OF CEFALY® IN NON-MIGRAINOUS HEADACHE

to control the pain. Cyclobenzaprine, amitryptiline,

cyproheptadine, topiramate and sodium divalproate were

also ineffective in modulating pain, as were analgesic

blocks with 5% lidocaine associated with dexamethasone

and onabotulinum-A toxin injections in the upper trapezius

muscles. To achieve partial pain relief the patient had to

use a tramadol/acetaminophen combination daily. Before

referring the patient for bilateral occipital nerve stimulation,

it was decided to prescribe Cefaly®,

(1)

since convergence

mechanisms are believed to be reciprocal, i.e., occipital

nerve stimulation is reported to relieve headaches occurring

in the trigeminal nerve territories.

(2,3)

Since the first day using Cefaly®, the patient

experienced a decrease in headache intensity. He

continued using Cefaly® program 1 daily for 20 minutes

at bedtime, with a progressive decrease in the occipital

headache and nuchal pain and was able to stop using

5% lidocaine patches and most of the OTC analgesic

drugs immediately. At his three-month follow-up, he

reported that he was still experiencing an improvement in

the region of 80%.

Cefaly® has been used for episodic migraine, but its

usefulness for chronic migraine or other headaches has yet

to be determined. This confirms the findings about the mode

of action of Cefaly® showing that it modulates areas in the

pain matrix (anterior cingulate, orbitofrontal cortex) and

that is thus likely to be effective for other pain syndromes

besides migraine, or even headache.

(4)

The case described

here shows that Cefaly® may be effective in headaches

other than migraine and should perhaps be tried before

referring the patient for invasive neurostimulation

procedures.

Correspondence

Pedro André Kowacs, M.D., MSc

Head of the Neurology Division

Neurological Institute of Curitiba

Rua Jeremias Maciel Perretto 300

Curitiba, Brazil ZIP CODE 81210-310

pkowacs@gmail.com

Received: November 20, 2017

Accepted: December 28, 2017

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