Auricular percutaneous neuromodulation (aurimod®) for refractory migraine with medication overuse: A rapid-response case report

Introduction. Migraine is a leading cause of disability worldwide and is frequently complicated by medication overuse headache (MOH), in which excessive analgesic intake paradoxically perpetuates pain (Headache Classification Committee, 2018). Despite advances in pharmacological therapies, a subset of patients remains refractory. Auricular neuromodulation is an emerging non-pharmacological approach targeting cranial and autonomic pathways through the dense innervation of the auricle, including vagal and trigeminal afferents.Methods. We report the case of a 42-year-old woman with chronic migraine without aura, characterized by daily attacks (Numerical Rating Scale [NRS] 10/10), photophobia, phonophobia, nausea, and marked functional impairment. The patient reported daily intake of metamizole (up to five doses/day), fulfilling diagnostic criteria for MOH (ICHD-3). Previous treatments, including NSAIDs, triptans, magnesium, and β-blockers, were ineffective or poorly tolerated. The Aurimod® system was applied to the left auricle, targeting standardized neuromodulation points (including Shen Men, trigeminal, autonomic, and cervical plexus areas), with each application maintained for 96 hours. A second session was performed one week later.Results. After the first application, pain rapidly decreased from NRS 10 to NRS 4 within hours, with complete discontinuation of analgesic intake and improved sensory tolerance. Following the second application, complete pain resolution (NRS 0) was achieved, with no further migraine attacks and no need for rescue medication. No local or systemic adverse events were observed. At 4-week follow-up, the patient maintained sustained benefit, reporting only mild tension-type discomfort (NRS 1–2) not requiring pharmacological treatment.Conclusions. This case demonstrates a rapid and clinically meaningful response to auricular percutaneous neuromodulation in refractory migraine with medication overuse. The intervention was associated with immediate analgesic discontinuation and sustained symptom control. These findings support the potential role of auricular neuromodulation in breaking MOH cycles and modulating central pain pathways. Further controlled studies are needed to confirm efficacy, define patient selection, and evaluate long-term outcomes.