Migraine Management

A new treatment using electrical impulses brings real relief.

Electrical impulses -- transmitted to a nerve at the base of the brain -- are bringing life-changing relief to some chronic migraine sufferers. An estimated 28 million Americans live with migraine headaches. Another 6.5 million (2.2 percent of the U.S. population) have chronic migraine pain -- headaches more than 15 days a month. Medications to treat and prevent migraine headaches have improved in the past decade, but for some patients, nothing works.

"If you have a migraine every day or almost every day, it's completely disabling," says David Dodick, M.D., a neurologist at Mayo Clinic in Scottsdale, Ariz. The new electrical impulse treatment, called occipital nerve stimulation, offers hope for that subset of patients.

In occipital nerve therapy, surgeons implant a 2-inch, paddle-shaped device at the base of the skull near the occipital nerve. Wires that run from the paddle under the skin connect to a pacemaker that is implanted either under the clavicle, under the skin in the lower back, or in the lower abdomen. Research is being conducted on another small device that doesn't require the implantation of wires or pacemakers.

Patients use a remote control to set the frequency and amplitude of the electrical impulses that the pacemaker sends to the occipital nerve. "Some patients leave the pacemaker on all the time to help prevent migraine headaches," Dr. Dodick says. "Others use it on an as-needed basis, much like taking a pain reliever."

Occipital nerve stimulation relieves migraine pain for many who have tried it. In one study with 16 patients at Mayo Clinic, eight patients reported 50 percent to 95 percent relief; two had complete relief; and six had no change or less than 50 percent relief.

Three international studies are underway to learn more about the therapy and its effectiveness, since researchers aren't sure why it works. "The electrical impulses may be blocking pain at the level of the spinal cord and brain stem; or, they may be activating the brain's own internal pain control network," Dr. Dodick says.

For chronic migraine sufferers, why it works may not be critical. What's important is that they may be able to return to many normal activities, without fear of a disabling migraine attack.

The devices are implanted during outpatient surgery. There is a small risk of infection with the implant, and it's possible that the wires may migrate, which may require surgery to reposition them. "For people who suffer from daily or near-daily headaches and have tried many treatments without relief, occipital nerve stimulation may be an important new approach," Dr. Dodick says.