Occipital Nerve Stimulation for Treatment of Migraine Headache
Victoria Yakovleva, MD, Alexander E. Yakovlev, MD, Sergey A. Karasev, MD
From Comprehensive Pain Management of the Fox Valley, Appleton, WI, USA
Running title: Alternative approach to migraine headache
INTRODUCTION
Migraine is a primary headache disorder affecting 18% of women and 6% of men in US. Control of migraine headache can be difficult to achieve in the group of patients who do not respond to accepted medical treatment or cannot tolerate side effects of medications used to treat migraine. Occipital nerve stimulation (ONS) has been used to treat patients with occipital neuralgia but recently this type of treatment is utilized to control different headaches including migraine and cluster headaches.
MATERIALS AND METHODS
The patient is a 42 year old female with 15 years history of migraine headaches who failed conservative medical treatment in the past. She had short lasting pain relief after right lesser and greater occipital nerve block. She underwent a successful trial of percutaneous placement of an 8-electrode subcutaneous lead (Medtronic Inc., Minneapolis, MN) in right occipital region on the level of C 1. During the 3 day ONS trial, the patient had good control of headaches. Two weeks later the patient underwent subdermal implantation of a permanent lead in right occipital region and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator over right supragluteal area.
RESULTS
After ONS implantation, the patient’s headaches were well controlled. The patient reported over 50% decrease in headache days per month and 4 to 5 point drop on VAS score during migraine attacks. The patient was able to suppress the migraine headache in 30–40 minutes after initiating use of the ONS. She was able to discontinued the use of all medications for preventive and acute therapy of
migraine. The patient also reported other positive outcomes including the opportunity to start school and improved relations with friends and family. At 18 months post-implant, the patient continued to report good control of the migraine headache.
CONCLUSION
ONS can be a new therapeutic option for patients with intractable migraine headache who did not responded to currently established treatments. This neuromodulation technique decreases the intensity of pain during migraine attacks and can lead to significant reduction in the number of headache days per month.
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