Use of percutaneous electrical nerve stimulation (PENS) in the short-term management of headache

Objective.-To evaluate the short-term effects of percutaneous electrical ne rve stimulation (PENS) in the management of three types of chronic headache . Background.-Traditional electroanalgesic therapies have been reported to be effective in the management of acute headache symptoms. However, no contro lled studies have been performed in patients with chronic headache. Methods.-Thirty patients with either tension headache, migraine, or posttra umatic headache symptoms of at least 6 months' duration were randomized to receive PENS (needles with electricity) or "needles alone" according to a c rossover study design. All treatments were administered for 30 minutes, thr ee times a week for 2 consecutive weeks with 1 week off between the two dif ferent treatments. For the PENS treatments, an alternating electrical stimu lation frequency of 15 and 30 Hz was used. Pain, activity, and sleep scores were assessed using a 10-cm visual analog scale, with 0 corresponding to t he best and 10 to the worst, during the 48-hour period prior to the beginni ng of the two treatments, immediately before and after each treatment sessi on, and 48 hours after completing each treatment modality. Results.-Compared with the needles alone, PENS therapy was significantly mo re effective in decreasing the overall VAS pain scores for tension-type hea dache, migraine and posttraumatic headache (58%, 59%, and 52% versus 20%, 1 5%, and 20%, respectively). Similarly, PENS therapy produced greater improv ement in the patients' physical activity (41% to 58% for PENS versus 11% to 21% for needles only) and quality of sleep (41% to 48% for PENS versus 12% to 20% for needles only). However, there were no differences in the patter n of the response to PENS therapy among the three headache groups. Conclusions.-Percutaneous electrical nerve stimulation appears to be a usef ul complementary therapy to analgesic and antimigraine drugs for the short- term management of headache. Interestingly, the analgesic response to PENS therapy appears to be independent of the origin of the headache symptoms.