Objective: To explore the effectiveness of perineural injection treatment with dextrose (PITD) as a cost-effective and accessible alternative for managing refractory chronic migraine in low- and middle-income countries (LMICs).
Case Report: A single-patient case study was conducted involving a 30-year-old male diagnosed with chronic migraine complicated by medication-overuse headache, based on the International Classification of Headache Disorders, 3rd edition (ICHD-3). The patient had a one-year history of right-sided daily headaches refractory to over-the-counter analgesics and conventional prophylactic therapy.
Comprehensive neurological and physical examinations were performed, followed by diagnostic investigations including electroencephalography (EEG), magnetic resonance imaging (MRI), and transcranial Doppler (TCD), all of which showed no structural or vascular abnormalities.
The therapeutic intervention consisted of biweekly perineural injection treatment with 5% dextrose (PITD), administered bilaterally to the greater and lesser occipital nerves (GON and LON). Each session involved 5 cc of 5% dextrose per side, guided by anatomical landmarks and palpation of tender points.
Concurrent pharmacological management included topiramate (50 mg twice daily) and low-dose amitriptyline (12.5 mg at bedtime). A rescue regimen of paracetamol and oral diazepam was provided for breakthrough attacks. The treatment period lasted three months, with progress assessed using the Numerical Pain Rating Scale (NPRS) at each follow-up visit.
Discussion: The patient reported significant improvement in pain severity, with the Numerical Pain Rating Scale (NPRS) decreasing from 9 to 5 over the three-month treatment period. Sustained relief was achieved by the fifth PITD session, with stabilization of symptoms and no structural abnormalities detected on follow-up MRI.
Conclusions: PITD may offer a viable, low-cost treatment for chronic migraine in resource-constrained settings, addressing both peripheral and central mechanisms of pain. This approach could reduce reliance on expensive treatments and improve patient outcomes in LMICs. Further studies are needed to validate its efficacy and long-term benefits in larger populations.