Occipital Nerve Stimulation
Occipital Nerve Stimulation in Chronic Intractable Headaches
Due to the multifactorial and multidimensional nature of headaches, effective treatment and prevention continues to challenge the health care establishment. Billions of dollars are spend annually in the diagnosis, and treatment of headaches;not to mention the loss in productivity.
What is Occipital Nerve Stimulation (ONS)?
Occipital Nerve Stimulation is a new and exiting method of treating chronic intractable headaches of multiple etiologies, which have failed conservative and interventional therapy.
It consists of placing a peripheral lead (stimulator) under the skin, overlying the greater and/or lesser occipital nerves. These nerves supply the skin sensation behind your ear, base of the neck, head and side of your temple. It effectively modulates the nerve transmission of C2, C3 occipital nerve, altering the signal prior to entering the spinal cord. A pleasant tingling sensation is perceived over the occipital, area instead of pain.
Who Is a Candidate for ONS?
Patients suffering from headaches, which usually start at the base of the neck and radiates into the temporal area (above the ear). These headaches may be associated with migraine symptoms. A complete and thorough work up by the referring physician is required. Most patients have undergone and not responded to interventions such as: tens, medication management, injections, physical therapy, biofeedback and surgery.
Types of headaches that may respond to ONS are:
- Migraine, Cluster, Tension, Transformed Migraine, Others
- Occipital Neuralgia
- Cervical Spine Disorders
- Neuropathic Nerve Conditions associated with headaches: Chemotherapy, Vascular, Traumatic, Infectious, Idiopathic, Thalamic, etc.
Initially trial stimulation is performed to assess the effectiveness of Occipital Nerve Stimulation (ONS) in reducing the intensity and frequency of the headaches. A trial lead(s) is inserted in the subcutaneous tissue overlying the occipital nerve. It is then attached to the stimulating device (small computer). You are instructed in how to use the device and then discharged home for the trial period.
For patients undergoing permanent implantation, the procedure is very similar. The main difference is that a battery (similar to a pacemaker) is implanted at a distant site (usually the buttock or under your clavicle). The procedure is performed under local anesthesia with intravenous sedation, as an outpatient.
After the Procedure
During the trial phase, the patient will be given a pain diary to assess the effectiveness of the stimulation. In approximately 4-5 days, the patient will return to the office for evaluation and removal of the temporary lead. If the patient reports a significant (usually greater than 50%) reduction in the frequency and intensity of the headaches, then permanent implantation is recommended.
Surgery for permanent implantation consists of inserting the leads under the skin and connecting them to a unit (like a pacemaker) called the generator. The generator contains a small computer chip and a battery. There are different kinds of generators. Some are rechargeable and others have to be replaced every 3-5 years according to the specific use. This device is implanted under the skin overlying your buttock or under the clavicle, according to your preference.
In patients with successful trials, the vast majority obtains significant pain relief. This varies from 80-90 %. Greater than 50% of the patients stop using pain medications altogether. The rests, report significant decrease in intake and resume their normal activities of daily living.