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.

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Available from: Nagy A Mekhail, Aug 18, 2014
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    • "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]. "
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    • "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]. "
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    Preview · Article · May 2012 · Therapeutic Advances in Neurological Disorders
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    • "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). "
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