What is occipital nerve stimulation?

Updated: Oct 11, 2018
  • Author: Antonios Mammis, MD; Chief Editor: Jonathan P Miller, MD  more...
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Occipital nerve stimulation (ONS) is a form of neuromodulation therapy aimed at treating headache and craniofacial pain. This therapy involves an implantable device composed of an electrode and pulse generator. The lead is placed into the subcutaneous tissues innervated by the greater and lesser occipital nerves, and the pulse generator is implanted into a subcutaneous pocket in the chest, abdomen, or back.

Prior to implantation, a trial is performed in which leads are placed under the skin and are connected to an external battery. The trial is performed under sedation, and the patient is discharged the same day. Afterward, the patient tries the therapy for 4–7 days and keeps a detailed pain diary.

A permanent device is implanted only if the patient reports significant improvements in pain and quality of life. The permanent implantation is placed under sedation or anesthesia, and the patient is discharged the same day.

The device is programmed by a clinical specialist appointed by the manufacturer.

This type of therapy has been evolving as a treatment for intractable occipital headache syndromes since the first implant in 1993, and the data to support its use are robust. Multiple authors have reported that successful neuromodulation for occipital headache syndromes can be accomplished with subcutaneous regional electrode placement. Available literature on the use of peripheral neurostimulation for headache includes occipital nerve stimulation, supraorbital nerve stimulation, and infraorbital nerve stimulation. Recently, other neurostimulatory techniques such as cervical epidural neurostimulation have been explored for cluster headaches, as well. [1]  

Neurostimulation is FDA-approved for the treatment of certain intractable pain syndromes, although it is not approved for headache, chronic migraine, and craniofacial pain and thus occipital nerve stimulation continues to represent an off-label use.

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