Background and Aims A considerable number of patients suffering with cervicogenic headaches, occipital neuralgia, and facial pain due to various causes may not respond to standard medical therapy. High cervical spinal cord stimulation (SCS) may be a promising new therapy option.

Methods We present our experience of four cases.

Results 1st Case: A 44 y old female suffering with left-sided occipital, shoulder and facial pain due to trigeminal neuropathy was implanted with two eight-contact leads (tip at C1). With burst stimulation for facial pain and paraesthesia for the occipital and shoulder pain she reported 80% pain relief at 18 months.

2nd Case: A 42 y old male, was implanted with SCS for right brachialgia, neck pain and occipital neuralgia following a right C5/6 foraminotomy and decompression. He received a right sixteen-contact lead and a left eight-contact lead with (tip at C1). After 6 months he reported 80% pain relief with subperception stimulation (contour/microburst).

3rd case: A 52 y old male suffering with right occipital pain and dysesthesia after right shoulder decompression, was implanted with two eight-contact leads (tips at C2). A month post implantation he reported 90% pain relief with subperception stimulation.

4thcase: A 33 yr old lady with sustained neuropathic pain of the left maxillary(V₂) and mandibular(V₃) nerves and limited mouth opening, was implanted with a sixteen-contact lead (tip at C1/C2). Following instigation of subperception burst stimulation she reported 90% pain relief and improved mouth opening.

Conclusions All our patients report excellent pain relief with high cervical SCS with posterolateral lead placement for occipital and facial neuropathic pain and cervicogenic headaches.