I have chronic migraines and have had varying degrees of success with different treatments. Could occipital nerve stimulation help?
Answers from Jerry W. Swanson, M.D.
Occipital nerve stimulation is a surgical procedure that may be useful in the treatment of chronic and severe headache disorders, such as chronic migraines, that do not respond well to other therapies.
Occipital nerve stimulation was first used to treat headaches in 1977, but it's still considered a treatment in development.
The occipital nerve originates at the base of the neck. In occipital nerve stimulation, your doctor implants a small device at the base of the skull with leads connected to a power source (pulse generator) that sends electrical impulses to the occipital nerve.
The pulse generator is often implanted under the collarbone (clavicle), but the abdominal and buttock (gluteal) areas also are options.
Risks associated with occipital nerve stimulation include the possible need for surgical revision of wire placement after the procedure, as well as infection, pain and muscle spasms.
Research shows occipital nerve stimulation may improve headaches for some people, but the results are inconsistent.
In addition, studies on occipital nerve stimulation so far have included only a small number of participants, and long-term results are limited.
One study suggested about 40 percent of people with chronic migraine reported a sustained benefit up to four years after occipital nerve stimulation. Another suggested a similar benefit for people with chronic cluster headache up to six years after treatment. But both of these studies were without a blinded comparison group (uncontrolled), and a placebo effect may explain some of these benefits.
The bottom line? Although there's some evidence that occipital nerve stimulation may be effective in the treatment of chronic headache disorders, more studies are needed before the approach can be considered a routine headache treatment.
Sept. 24, 2016
- Paemeleire K, et al. Occipital nerve stimulation for headache disorders. Neurotherapeutics: The Journal of the American Society for Experimental Neurotherapeutics. 2010;7:213.
- Miller S, et al. Long-term outcomes of occipital nerve stimulation for chronic migraine: A cohort of 53 patients. The Journal of Headache and Pain. 2016;17:68.
- Magis D, et al. Neurostimulation therapies for primary headache disorders: Present and future. Current Opinion in Neurology. 2012;25:269.
- Jenkins B, et al. Neurostimulation for primary headache disorders, part 1: Pathophysiology and anatomy, history of neuromodulation in headache treatment, and review of peripheral neuromodulation in primary headaches. Headache. 2011;51:1254.
- Garza I. Chronic migraine. http://www.uptodate.com/home. Accessed Sept. 9, 2016.
- Dodick DW, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: Long-term results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2015;35:344.
- Saper JR, et al. Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalalgia. 2011;31:271.
- Brewer AC, et al. Long-term outcome in occipital nerve stimulation patients with medically intractable primary headache disorders. Neuromodulation. 2013;16:557.
- Leone M., et al. Long-term occipital nerve stimulation for drug-resistant chronic cluster headache. Cephalalgia. In press. Accessed Sept. 9, 2016.
- Starling AJ. A Narrative Review of Evidence-Based Preventive Options for Chronic Migraine. Current Pain and Headache Reports. 2015;19:49.
- Hayek SM, et al. Occipital neurostimulation. In: Neurostimulation for the Treatment of Chronic Pain. Philadelphia, Pa.: Saunders Elsevier; 2012. http://clinicalkey.com. Accessed Sept. 12, 2016.