Occipital Nerve Electrical Stimulation via the Midline Approach and Subcutaneous Surgical Leads for Treatment of Severe Occipital Neuralgia: A Pilot Study

Pain Management Center, The Cleveland Clinic Foundation, 9500 Euclid Ave., Desk C25, Cleveland, OH 44195, USA.
Anesthesia & Analgesia (Impact Factor: 3.47). 08/2005; 101(1):171-4, table of contents. DOI: 10.1213/01.ANE.0000156207.73396.8E
Source: PubMed


Persistent occipital neuralgia can produce severe headaches that may not be controllable by conservative or surgical approaches. We describe a case series of 6 patients who had chronic headaches over an average of 4.9 yr who underwent occipital nerve electrical stimulation lead implantation using a modified midline approach. The patients had received conservative and surgical therapies in the past including oral antidepressants, membrane stabilizers, opioids, occipital nerve blocks, and radiofrequency ablations. Significant decreases in pain visual analog scale (VAS) scores and drastic improvement in functional capacity were observed during the occipital stimulation trial and during the 3-mo follow-up after implantation. The mean VAS score changed from 8.66 +/- 1.0 to 2.5 +/- 1.3 whereas pain disability index improved from 49.8 +/- 15.9 to 14.0 +/- 7.4. Our midline approach has several advantages compared with the submastoid approach used elsewhere. There is only one small midline incision over the upper neck and the strain on the lead extension occurs only with flexion and is minimal with lateral flexion and rotation, which contributes to overall stability of this system.

Download full-text


Available from: Nagy A Mekhail, Aug 18, 2014
57 Reads
  • Source
    • "Nerve blocks to target the greater and lesser occipital nerves from dorsal ramus of C2 and C3 can be both diagnostic and therapeutic. Persistent headache secondary to occipital neuralgia may be amenable to occipital neurostimulation [9, 10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cervicogenic headache (CGH) is defined as referred pain from various cervical structures innervated by the upper three cervical spinal nerves. Such structures are potential pain generators, and include the atlanto-occipital joint, atlantoaxial joint, C2-3 zygapophysial joint, C2-3 intervertebral disc, cervical myofascial trigger points, as well as the cervical spinal nerves. Various interventional techniques, including cervical epidural steroid injection (CESI), have been proposed to treat this disorder. And while steroids administered by cervical epidural injection have been used in clinical practice to provide anti-inflammatory and analgesic effects that may alleviate pain in patients with CGH, the use of CESI in the diagnosis and treatment of CGH remains controversial. This article describes the neuroanatomy, neurophysiology, and classification of CGH as well as a review of the available literature describing CESI as treatment for this debilitating condition.
    Current Pain and Headache Reports 09/2014; 18(9):442. DOI:10.1007/s11916-014-0442-3 · 2.26 Impact Factor
  • Source
    • "Occipital nerve stimulation (ONS) had been proposed as a treatment for refractory migraine [Matharu et al. 2004; Popeney and Alo, 2003], occipital neuralgia [Johnstone and Sundaraj, 2006; Kapural et al. 2005; Slavin et al. 2006] and other intractable headache disorders [Weiner and Reed, 1999]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Neurostimulation techniques for the treatment of primary headache syndromes, particularly of chronic cluster headache, have received much interest in recent years. Occipital nerve stimulation (ONS) has yielded favourable clinical results and, despite the limited numbers of published cases, is becoming a routine treatment for refractory chronic cluster headache in specialized centres. Meanwhile, other promising techniques such as spinal cord stimulation (SCS) or sphenopalate ganglion stimulation have emerged. In this article the current state of clinical research for neurostimulation techniques for chronic cluster headache is reviewed.
    Therapeutic Advances in Neurological Disorders 05/2012; 5(3):175-80. DOI:10.1177/1756285612443300 · 3.14 Impact Factor
  • Source
    • "After a mean follow-up of 22 months, 70% of these patients still had good results. Other studies also report comparable results6,11). However, occipital nerve stimulation may be associated with possible complications such as infection, lead migration, hardware erosions, electrode fractures, disconnections, and sepsis13). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Occipital neuralgia is characterized by paroxysmal jabbing pain in the dermatomes of the greater or lesser occipital nerves caused by irritation of these nerves. Although several therapies have been reported, they have only temporary therapeutic effects. We report the results of pulsed radiofrequency treatment of the occipital nerve, which was used to treat occipital neuralgia. Patients were diagnosed with occipital neuralgia according to the International Classification of Headache Disorders classification criteria. We performed pulsed radiofrequency neuromodulation when patients presented with clinical findings suggestive occipital neuralgia with positive diagnostic block of the occipital nerves with local anesthetics. Patients were analyzed according to age, duration of symptoms, surgical results, complications and recurrence. Pain was measured every month after the procedure using the visual analog and total pain indexes. From 2010, ten patients were included in the study. The mean age was 52 years (34-70 years). The mean follow-up period was 7.5 months (6-10 months). Mean Visual Analog Scale and mean total pain index scores declined by 6.1 units and 192.1 units, respectively, during the follow-up period. No complications were reported. Pulsed radiofrequency neuromodulation of the occipital nerve is an effective treatment for occipital neuralgia. Further controlled prospective studies are necessary to evaluate the exact effects and long-term outcomes of this treatment method.
    Journal of Korean Neurosurgical Society 05/2012; 51(5):281-5. DOI:10.3340/jkns.2012.51.5.281 · 0.64 Impact Factor
Show more