BACKGROUND: Nummular headache is a rare primary headache disorder that is often difficult to treat and frequently resistant to conventional therapies. We report the first case of a permanent peripheral nerve field stimulation (PNFS) implant utilizing Fast-Acting Sub-perception Therapy (FAST™) for the treatment of nummular headache.

CASE REPORT: A 45-year-old man with a 4-year history of severe right temporal nummular headache was initially successfully managed with percutaneous electrical nerve stimulation therapy. However, lack of long-term pain relief necessitated consideration of a permanent PNFS implant. The procedure involved placement of 2 linear electrodes and an implantable pulse generator. Following activation with FAST™, the patient experienced immediate and sustained pain relief, with resolution of allodynia, and has remained pain-free at 2 years of follow-up.

CONCLUSIONS: This case demonstrates the potential efficacy and long-term benefit of peripheral nerve field stimulation using FAST™ therapy in the management of refractory nummular headache.

KEYWORDS: Nummular headache; peripheral nerve field stimulation; fast-acting sub-perception therapy; neuromodulation