gms | German Medical Science

Objective: Migraine is highly prevalent along with the high percentage of treatment-refractory cases. ONS may provide pain relief for patients with otherwise refractory primary headache disorders. It is more generally applicable than other invasive methods. We investigated ONS in a series of patients to determine efficacy, complications and outcome.

Methods: We included a case series of 6 patients who had chronic headaches for a duration of 3.8yo who underwent ONS lead implantation (SJM, Octrode). Prior to surgery patients had received conservative and surgical therapies including antidepressants, occipital nerve blocks, opioids, cervical posterior fusion (one patient), without success. Four patients suffered from chronic migraine, one had a history of thalamic infarction, one patient suffered from cluster headache. Using a midline approach two octrodes were placed subcutaneously and positioned across the level of C1 using fluoroscopy. Leads were placed under general anesthesia and externalized for three days.

Results: All patients mentioned significant relief of pain, so that they all underwent insertion of the generator (eon MINI, SJM). Decreases in pain led to an improvement in functional capacity during the 3-month follow-up after implantation. The mean VAS score changed from 7.5±1.5 to 2.5±1.3 at the 3-month follow-up. No complications occurred.

Conclusions: The exact mechanism of neuromodulation in the treatment of different headache syndromes remains unclear. ONS appears to be both safe and efficacious for the treatment of medically intractable headaches conditions. Further investigations are required to evaluate criteria’s for patient selection, stimulation targets and parameters and device programming, and will further improve the clinical results.