Current Pain and Headache Reports

, Volume 12, Issue 1, pp 62–66 | Cite as

Occipital nerve stimulation for medically intractable headache

Article

Abstract

There is an unmet need, and thus a continued search, for effective treatments for patients with chronic daily headache who do not respond to or tolerate conventional therapies. Recent interest has focused on the use of occipital nerve stimulation (ONS) to treat patients with chronic, disabling headaches who are not adequately controlled by usual therapies. A small but growing body of evidence supports the use of ONS for the treatment of intractable headache. Electrical stimulation of the occipital nerve has both peripheral and central nervous system effects that modulate nociception. The exact role for ONS will evolve as our understandings of its physiologic effects, efficacy, and safety grow.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Scher A, Stewart WF, Liberman J, Lipton RB: Prevalence of frequent headache in a population sample. Headache 1998, 38:497–506.PubMedCrossRefGoogle Scholar
  2. 2.
    Natsis K, Baraliakos X, Appell HJ, et al.: The course of the greater occipital nerve in the suboccipital region: a proposal for setting landmarks for local anesthesia in patients with occipital neuralgia. Clin Anat 2006, 19:332–336.PubMedCrossRefGoogle Scholar
  3. 3.
    Poletti CE: C2 and C3 pain dermatomes in man. Cephalalgia 1991, 11:155–159.PubMedCrossRefGoogle Scholar
  4. 4.
    Trentman TL, Dodick DW, Zimmerman RS, Seth N: Stimulation ranges, usage ranges, and paresthesia mapping during occipital stimulation. Neuromodulation 2008, In press.Google Scholar
  5. 5.
    Goadsby PJ, Knight YE, Hoskin KL: Stimulation of the greater occipital nerve increases metabolic activity in the trigeminal nucleus caudalis and cervical dorsal horn of the cat. Pain 1997, 73:23–28.PubMedCrossRefGoogle Scholar
  6. 6.
    Piovesan EJ, Kowacs PA, Tatsui CE, et al.: Referred pain after painful stimulation of the greater occipital nerve in humans: evidence of convergence of cervical afferences on trigeminal nuclei. Cephalalgia 2001, 21:107–109.PubMedCrossRefGoogle Scholar
  7. 7.
    Bartsch T, Goadsby PJ: Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002, 125:1496–1509.PubMedCrossRefGoogle Scholar
  8. 8.
    Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965, 150:971–979.PubMedCrossRefGoogle Scholar
  9. 9.
    Ignelzi RJ, Nyquist JK: Direct effect of electrical stimulation on peripheral nerve evoked activity: implications in pain relief. J Neurosurg 1976, 45:159–165.PubMedCrossRefGoogle Scholar
  10. 10.
    Matharu MS, Bartsch T, Ward N, et al.: Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 2004, 127:220–230.PubMedCrossRefGoogle Scholar
  11. 11.
    Schwedt TJ, Dodick DW, Trentman TL, Zimmerman RS: Response to occipital nerve block is not useful in predicting efficacy of occipital nerve stimulation. Cephalalgia 2007, 27:271–274.PubMedCrossRefGoogle Scholar
  12. 12.
    Weiner RL, Reed KL: Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation 1999, 2:217–221.CrossRefGoogle Scholar
  13. 13.
    Oh MY, Ortega J, Bellotte JB, et al.: Peripheral nerve stimulation for the treatment of occipital neuralgia and transformed migraine using a C1-2-3 subcutaneous paddle style electrode: a technical report. Neuromodulation 2004, 7:103–112.CrossRefGoogle Scholar
  14. 14.
    Kapural L, Mekhail N, Hayek SM, et al.: Occipital nerve electrical stimulation via the midline approach and subcutaneous surgical leads for treatment of severe occipital neuralgia: a pilot study. Anesth Analg 2005, 101:171–174.PubMedCrossRefGoogle Scholar
  15. 15.
    Slavin KV, Nersesyan H, Wess C: Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery 2006, 58:112–119.PubMedCrossRefGoogle Scholar
  16. 16.
    Popeney CA, Aló KM: Peripheral neurostimulation for the treatment of chronic, disabling, transformed migraine. Headache 2003, 43:369–375.PubMedCrossRefGoogle Scholar
  17. 17.
    Schwedt TJ, Dodick DW, Hentz J, et al.: Occipital nerve stimulation for chronic headache—long-term safety and efficacy. Cephalalgia 2007, 27:153–157.PubMedCrossRefGoogle Scholar
  18. 18.
    Burns B, Watkins L, Goadsby PJ: Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 2007, 369:1099–1106.PubMedCrossRefGoogle Scholar
  19. 19.
    Magis D, Allena M, Bolla M, et al.: Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 2007, 6:314–321.PubMedCrossRefGoogle Scholar
  20. 20.
    Schwedt TJ, Dodick DW, Trentman TL, Zimmerman RS: Occipital nerve stimulation for chronic cluster headache and hemicrania continua: pain relief and persistence of autonomic features. Cephalalgia 2006, 26:1025–1027.PubMedCrossRefGoogle Scholar
  21. 21.
    Melvin EA, Jordan FR, Weiner RL, Primm D: Using peripheral stimulation to reduce the pain of C2-mediated occipital headaches: a preliminary report. Pain Physician 2007, 10:453–460.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Washington University School of MedicineWashington University Headache CenterSt. LouisUSA

Personalised recommendations