Lead migration and postdural puncture headache following spinal cord stimulator placement in patient with cough: a case report.

Introduction and importance: Spinal cord stimulator (SCS) implantation has become a well-validated treatment for refractory chronic back pain. While generally safe, complications such as lead migration and postdural puncture headache (PDPH) can arise. Recognizing these hardware and biologic complications is crucial to improving outcomes and guiding management strategies. Case presentation: A middle-aged male with chronic nocturnal cough underwent successful percutaneous SCS trial placement under fluoroscopic guidance. Adequate pain coverage was confirmed, and he was discharged home. The following day, he returned with a positional headache, nausea, and imaging-confirmed lead migration. PDPH was suspected. At the time of presentation, a chest X-ray revealed possible lead migration, and the patient had also reported a chronic dry cough that had worsened the evening of the procedure. Management included removal of the leads and an epidural blood patch, leading to complete symptom resolution. Clinical discussion: Nocturnal coughing is hypothesized to have caused mechanical stress on the SCS leads, resulting in caudal migration. Lead migration is one of the most common SCS complications, with rates of 2.1-27%. Additionally, PDPH, though rare (~0.81% per lead placed), often requires an epidural blood patch for effective resolution. In this case, the displaced leads may have exacerbated an underlying dural tear, highlighting a novel interplay between hardware and biological complications. Conclusion: This is the first documented case at our academic center of concurrent lead migration and PDPH following SCS placement. Our findings suggest that chronic coughing may represent an unrecognized risk factor for lead migration and PDPH. Providers should address unresolved coughing prior to SCS implantation and consider improved anchoring techniques to minimize risks.