A 12-year-old boy developed a headaches and was diagnosed with migraines. He continued to have headaches and vomiting, with a numerical rating scale (NRS) of 8–10 and was referred to our department. He was taking naratriptan more than 10 times/month. We explained the need to discontinue it; however, he continued to have headaches with an NRS of 5–8 and was taking ibuprofen 1–2 times/day. A sphenopalatine ganglion block by intranasal local anesthetic infiltration was performed, and the headaches were reduced to an NRS of 3. He was started on amitriptyline 10 mg, sphenopalatine ganglion block every 2–4 weeks, and ibuprofen 2–3 times/month for seizures, and he was able to go to school without any restrictions. Sphenopalatine ganglion block by intranasal local anesthetic infiltration is minimally invasive and may be useful for symptom relief in pediatric patients with migraines who have poor pain control with medication alone.

Foot lesions such as ingrown toenails, calluses, and foot corns affect posture and gait, and may contribute to pain in patients with chronic lumbar disease. In this report, we describe a case of right big toe and lower back pain that was treated at a pain clinic. The patient was a male in his 60s who worked as a security guard. He had a history of left lower back and leg pain due to lumbar disc herniation (L3/4), and had undergone a lumbar epidural block. The patient first visited our hospital with pain in the right big toe caused by an ingrown toenail, and foot care and physical therapy were initiated. Three months after the first visit, the right big toe pain was at an NRS 0, the right lower back pain was at an NRS 0–1, and gait had improved. In this case of chronic lumbar disease with foot lesions, pain was successfully managed by combining foot care by a nurse with exercise therapy by a physical therapist.

The safety of perinatal spinal cord stimulation (SCS) has not yet been confirmed. We report the case of a patient who continued to use SCS during the perinatal period, despite inadequate recharging due to weight gain. Case: At the age of 25, the patient developed right brachial plexus neuropathy and was treated with steroid pulse therapy. At the age of 27, she was referred to our department due to persistent fatigue, edema, and pain in the affected limb. Repeated brachial plexus blocks provided temporary relief. At the age of 28, she began using SCS, with an implantable pulse generator (IPG) placed in the buttock. At the age of 36, she reported pregnancy and used SCS nightly. She became aware of poor recharging after 34 weeks of pregnancy, during which her weight increased by 13 kg from her prepregnancy weight. She delivered vaginally at 38 weeks and 3 days and was discharged without complications. After delivery, the patient lost weight, and her IPG charge improved.

A 65-year-old male who had a car accident a year ago had been complaining of neck pain, neck stiffness, left upper limb pain and numbness. He was also suffering from persistent tinnitus and nausea. The patient was referred to our pain clinic to receive a cervical nerve root block. Initially, he underwent C6 nerve root block, which was not effective for upper limb symptoms, whereas greater occipital nerve block was effective to reduce his neck pain and stiffness. The greater occipital nerve block was extremely effective for tinnitus and nausea and achieved the patient's high satisfaction. We also applied pulsed radiofrequency (42℃, 2 Hz, 20 ms, 45 V, 6 min) to the greater occipital nerve under ultrasound guidance, which was effective for three months and decreased his depression scale. The greater occipital nerve block can be an effective treatment for tinnitus in traumatic cervical syndrome patients.