Long-Term Pain Reduction Does Not Imply Improved Functional Outcome in Patients Treated With Combined Supraorbital and Occipital Nerve Stimulation for Chronic Migraine

2016 ◽  
Vol 19 (5) ◽  
pp. 507-514 ◽  
Author(s):  
Shannon W. Clark ◽  
Chengyuan Wu ◽  
David W. Boorman ◽  
Nohra Chalouhi ◽  
Mario Zanaty ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Pain Reduction ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve

scholarly journals Occipital Nerve Stimulation for Refractory Chronic Migraine: Results of a Long-Term Prospective Study

2017 ◽  
Vol 1 (21;1) ◽  
pp. E151-E159 ◽  
Author(s):  
Dolores Rodrigo
Keyword(s):  
Surgical Technique ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Open Label ◽  
Occipital Nerve ◽  
Refractory Chronic Migraine

Background: Refractory chronic migraine affects approximately 4% of the population worldwide and results in severe pain, lifestyle limitations, and decreased quality of life. Occipital nerve stimulation (ONS) refers to the electric stimulation of the distal branches of greater and lesser occipital nerves; the surgical technique has previously been described and has demonstrated efficacy in the treatment of a wide variety of headache disorders. Objectives: The aim of this study is to evaluate the long-term efficacy and tolerability of ONS for medically intractable chronic migraine. Study Design: Prospective, long-term, open-label, uncontrolled observational study. Setting: Single public university hospital. Methods: Patients who met the International Headache Society criteria for chronic migraine, all of them having been previously treated with other therapeutic alternatives, and who met all inclusion and exclusion criteria for neurostimulation, received the implantation of an ONS system after a positive psychological evaluation and a positive response to a preliminary occipital nerve blockage. The implantation was performed in 2 phases: a 10 day trial with implanted occipital leads connected to an external stimulator and, if more than 50% pain relief was obtained, permanent pulse generator implantation and connection to the previously implanted leads. After the surgery, the patients were thoroughly evaluated annually using different scales: pain Visual Analogue Scale (VAS), number of migraine attacks per month, sleep quality, functionality in social and labor activities, reduction in pain medication, patient satisfaction, tolerability, and reasons for termination. The average follow-up time was 9.4 ± 6.1 years, and 31 patients completed a 7-year follow-up period. Results: Thirty-seven patients were enrolled and classified according to the location and quality of their pain, accompanying symptoms, work status, and psychological effects. Substantial pain reduction was obtained in most patients, and the VAS decreased by 4.9 ± 2.0 points. These results remained stable over the followup period. Five of the 35 permanently implanted patients with migraine attacks at baseline were free from these attacks at their last visits, whereas the pain severity decreased 3.8 ± 2.5 (according to the VAS) in the remaining patients. Seven of the 35 permanent implanted devices were definitively removed: 2 devices because of treatment inefficacy, and 5 devices because the patients were asymptomatic and considered to be cured from their pain, even with the stimulation off. Systemic side effects were not observed. Limitations: Limitations of the current study include its uncontrolled and open-label design. Additionally, not all patients completed the 7-year follow-up period. Conclusions: We consider that the trigemino-cervical autonomous and cervical connection may explain why ONS might relieve chronic migraine pain, but this is just a theoretical explanation which should be demonstrated in future studies. The results achieved in this study suggest that ONS may provide longterm benefits for patients with medically intractable chronic migraine. These outcomes are slightly better than previous reports and were maintained over the 7-year follow-up. We believe that an accurate selection of patients, realization of diagnostic occipital nerve blocks, psychological evaluations, rigorous surgical technique, and appropriate parameter programming helped us achieve these outcomes. Key words: Refractory chronic migraine, headache, occipital nerve stimulatino, peripheral nerve stimulation, occipital nerve block

scholarly journals Long-term outcomes of occipital nerve stimulation for chronic migraine: a cohort of 53 patients

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Sarah Miller ◽  
Laurence Watkins ◽  
Manjit Matharu
Keyword(s):  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Long Term Outcomes ◽  
Occipital Nerve

Occipital Nerve Stimulation for Chronic Refractory Migraine

2019 ◽  
pp. 157-162
Author(s):  
Cletus Cheyuo ◽  
Roy S. Hwang ◽  
Julie G. Pilitsis
Keyword(s):  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Significant Proportion ◽  
Preoperative Assessment ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Relevant Evidence ◽  
Planning Decision ◽  
Refractory Chronic Migraine ◽  
Refractory Migraine

Chronic migraine remains disabling for a significant proportion of the population and challenging for medical providers. In addition to pharmacological treatment, peripheral nerve stimulation has been shown to provide satisfactory pain relief and improved quality of life. In this chapter, an illustrative case of occipital nerve stimulation (ONS) for refractory chronic migraine is presented, including the preoperative assessment and planning, decision making process, detailed surgical technique, aftercare and follow-up. A complication and its management are also described and discussed in detail and supplemented with clinical pearls. This discussion is accompanied by a review of the relevant evidence and outcomes from the literature.

185 Long-term Follow-up in Functional Outcomes of Combined Supraorbital Nerve Stimulation and Occipital Nerve Stimulation for Chronic Headache Patients

Neurosurgery ◽  
2015 ◽  
Vol 62 ◽  
pp. 227-228
Author(s):  
Shannon Wang Clark ◽  
Chengyuan Wu ◽  
David Boorman ◽  
Nohra Chalouhi ◽  
Mario Zanaty ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Functional Outcomes ◽  
Chronic Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Supraorbital Nerve ◽  
Long Term Follow Up ◽  
Headache Patients

scholarly journals Burst Occipital Nerve Stimulation for Chronic Migraine and Chronic Cluster Headache

2019 ◽  
Vol 22 (5) ◽  
pp. 638-644 ◽  
Author(s):  
Rodrigo Garcia‐Ortega ◽  
Tamara Edwards ◽  
Liz Moir ◽  
Tipu Z. Aziz ◽  
Alexander L. Green ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve

Peripheral nerve stimulation registry for intractable migraine headache (RELIEF): a real-life perspective on the utility of occipital nerve stimulation for chronic migraine

2020 ◽  
Vol 162 (12) ◽  
pp. 3201-3211 ◽  
Author(s):  
Keyoumars Ashkan ◽  
Giannis Sokratous ◽  
Hartmut Göbel ◽  
Vivek Mehta ◽  
Astrid Gendolla ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Migraine Headache ◽  
Real Life ◽  
Peripheral Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Headache Relief

scholarly journals Occipital Nerve Stimulation for Chronic Migraine—A Systematic Review and Meta-Analysis

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0116786 ◽  
Author(s):  
Yen-Fu Chen ◽  
George Bramley ◽  
Gemma Unwin ◽  
Dalvina Hanu-Cernat ◽  
Janine Dretzke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Meta Analysis ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve

Occipital nerve block prior to occipital nerve stimulation for refractory chronic migraine and chronic cluster headache: Myth or prediction?

Cephalalgia ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 359-362 ◽  
Author(s):  
Thomas M Kinfe ◽  
Patrick Schuss ◽  
Hartmut Vatter
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Nerve Block ◽  
Nerve Stimulation ◽  
Predictive Value ◽  
Positive Response ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Occipital Nerve Block

Background Occipital nerve stimulation (ONS) results in beneficial outcomes, with marked pain relief, in otherwise intractable chronic migraine (CM) and chronic cluster headache (CCH). Some studies have reported that a positive response to occipital nerve block (ONB) administered prior to ONS predicts a positive response to ONS. However, other studies concerned with proper patient selection claimed no predictive value for ONB. The aim of this study was to re-evaluate the usefulness and predictive value of ONB prior to ONS. Methods Literature searches on the predictive value of ONB were performed in MEDLINE and PubMed. Patient data were extracted and a pooled analysis was performed. Results The literature review revealed 133 patients with CM and seven patients with CCH who received preoperative ONB. To date, a randomized controlled study examining the relationship between ONB and ONS has not been conducted in patients with CM. Conclusions Current literature suggests that ONB does not sufficiently predict ONS responsiveness in patients with refractory CM and CCH; this important issue requires further investigation.

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