Occipital Neurostimulation (ONS) for Treatment of Intractable Headache Disorders

Intractable migraine and other headache syndromes affect approximately 38 million Americans and many more millions worldwide. Although there are many treatment protocols mainly designed around medication regimens, there are estimated to be at least 5% of these headache sufferers that do not respond in a meaningful way to medications and whose lives can be severely restricted to darkened, quiet rooms, heavy doses of narcotics, failed personal relationships, and an overwhelming sense of hopelessness. Occipital neurostimulation using subcutaneously inserted cylindrical electrodes at the level of the C1 (occipitocervical junction) was pioneered by the author over the past 12 years is a relatively simple, minimally invasive technique for treating many of these intractable headache syndromes. Implanting percutaneously or surgically placed single or bilateral electrode arrays into the subcutaneous tissues, the patients perceive a gentle paresthesia sensation to the back of the head, blocking the painful areas from disorders including chronic daily transformed migraines, occipital neuralgia, cervicogenic headaches, and deafferentation neuropathic pain. Not all patients are responders; however, long-term follow-up to date consistently reflects a 70–75% success rate with greater than 50% pain reduction and diminished use of medications, particularly narcotics.