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 procedure that might be useful for the treatment of chronic and severe headache disorders that do not adequately respond to more conventional therapy, including chronic migraines. Although occipital nerve stimulation was first used for headaches in 1977, it's still a treatment in development.
Surgical procedures for occipital nerve stimulation vary. In general, a small device is implanted at the base of the skull, near the occipital nerve.
Your doctor connects the lead to a power source (pulse generator) that sends electrical impulses to the occipital nerve. Your doctor implants the pulse generator, often under the collarbone (clavicle), but the abdominal and buttock (gluteal) areas also are options.
After occipital nerve stimulation, the need for surgical revision of wire placement is common. Infection, pain and muscle spasms also are risks.
Research indicates that occipital nerve stimulation may improve headaches for some people who try the therapy.
However, studies on occipital nerve stimulation so far have included only a small number of participants and long-term results are limited.
The bottom line? Although there's 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.
Aug. 17, 2013
- Paemeleire K, et al. Occipital nerve stimulation for headache disorders. Neurotherapeutics: The Journal of the American Society for Experimental Neurotherapeutics. 2010;7:213.
- Trentman TL, et al. Occipital nerve stimulation: Technical and surgical aspects of implantation. Headache. 2008;48:319.
- 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 headeache disorders, part 1: Pathophysiology and anatomy, history of neuromodulation in headache treatment, and review of peripheral neuromodulation in primary headaches. Headache. 2011;51:1254.
- Schwedt TJ (expert opinion). Mayo Clinic, Phoenix, Ariz. June 26, 2013.
- Silberstein SD, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: Results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2012;32:1165.
- 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. In press. Accessed June 26, 2013.