Peripheral nerve stimulation for refractory headache after whiplash injury: a case report

BACKGROUND: Whiplash injuries frequently cause headaches, which can become refractory to conservative treatment. METHODS: We report a case of a patient with persistent post-whiplash headache treated with an 8-week course of ultrasound- and fluoroscopy-guided percutaneous peripheral nerve stimulation (PNS) targeting the greater occipital nerve. OUTCOMES MEASURED: Patient outcomes were assessed using standardized pain scores and validated Patient-Reported Outcomes Measurement Information System (PROMIS) scales, including measures of neuropathic pain, sleep disturbance, and physical function along with global patient satisfaction at baseline and at three-month and one-year follow-ups after device removal. RESULTS: The procedure reduced the patient's pain score from 10/10 to 1/10. At 3 months, the patient experienced significant improvements in sleep, physical function, and quality of life with 80-90% satisfaction. However, neuropathic pain scores worsened beyond baseline at 1 year, and physical function partially rebounded, suggesting strong short-term but uncertain long-term durability. Conclusion: Temporary PNS may offer short-term relief for refractory whiplash-associated headaches, though long-term durability requires further investigation.