Article
Subcutaneous stimulation of the greater occipital nerve for the treatment of chronic headache syndromes
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Authors
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Dirk Rasche
- Neurochirurgische Klinik, Universität zu Lübeck, Germany
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Volker Tronnier
- Neurochirurgische Klinik, Universität zu Lübeck, Germany
| Published: | September 16, 2010 |
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Outline
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Objective: In patients with chronic headache syndromes (CHS) which are refractory to any pharmacological treatment invasive techniques can be offered. In specific headache syndromes a dysfunction of the trigeminovascular system and hyperactivity in the hypothalamic area are supposed. Because of central connections of the greater occipital nerve and the trigeminal nerve in the upper spinal cord and brainstem peripheral nerve stimulation (PNS) is offered to those patients.
Methods: The greater occipital nerve is stimulated using subcutaneously placed leads at the level of C1/C2. Different techniques for lead placement and also different kinds of leads can be used. PNS is suprathreshold with pleasant paraesthesias in the distribution of the greater occipital nerve. In ten patients (4 pat. with chronic cluster headache (CCH), 2 pat. with chronic migraine (CM), 1 pat. with a combination of CCH and CM, 3 patients with occipital neuralgia (ON)) ipsi- or bilateral PNS was initiated and a test trial performed.
Results: After implantation a testing phase of at least 7 days was performed and different stimulation parameters were tested. In all patients a positive effect with pain reduction was documented, which was correlated with active and suprathreshold stimulation. Patients reported a decrease in attack frequency, intensity and duration. Even patients with permanent pain reported pain reduction of more than 50%. In all patients a neurostimulation device was implanted. During the mean follow up of 22 months (range: 6–54 months) one case each of lead dislocation and misconnection of the extension to the neurostimulator was observed and re-operated.
Conclusions: PNS of the greater occipital nerve offers an effective, simple and low-risk treatment option for patients with specific CHS like CCH, CM or ON. Even if no pain-free status can be achieved a significant pain reduction occurs. There is an urgent need for a prospective randomized trial comparing ONS with best medical and conservative treatment.
