Occipital nerve stimulation

Occipital nerve stimulation (ONS), also called peripheral nerve stimulation (PNS) of the occipital nerves, is used to treat chronic migraine patients who have failed to respond to pharmaceutical treatments. Occipital nerve stimulation (ONS), also called peripheral nerve stimulation (PNS) of the occipital nerves, is used to treat chronic migraine patients who have failed to respond to pharmaceutical treatments. The treatment involves the use of mild electrical impulses to stimulate the greater occipital nerve and lesser occipital nerve which are part of the peripheral nervous system and are located at the back of the head just above the neck area. The electrical impulses are generated by a small device called a neurostimulator – similar to an artificial cardiac pacemaker – which is implanted in the buttock, chest, low abdomen, beneath the shoulder blade or below the clavicle. The electricity is delivered to the greater occipital nerve and lesser occipital nerve by small metal electrodes which are arranged on thin leads and implanted just under the skin. The intensity of the electrical impulses can be adjusted using a small remote control device. The history of PNS is thoroughly reported by Slavin, 2011. The use of PNS for chronic pain was first reported in 1967 by Wall and Sweet although the first implantations were performed in 1962 by Shelden. They demonstrated that electrical stimulation of peripheral nerves suppresses the perception of pain. A period of semi-experimental PNS usage continued for 15 – 20 years. During the latter half of the 1980s, PNS became an established surgical procedure. In the late 1990s, Weiner and Reed reported the percutaneous technique of inserting electrodes in the vicinity of the occipital nerves to treat occipital neuralgia. Weiner showed that placing a PNS electrode close to a nerve is effective for pain relief and a technically simple procedure. This pioneering work heralded the start of the modern era of PNS. It was 2003 before Popeney and Aló proposed using PNS for the treatment of chronic migraine. Subsequently, prospective randomized controlled trials were launched to gather additional clinical evidence. This is further detailed in an article published by Cephalagia titled 'Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: Results from a randomized, multicenter, double-blinded, controlled study.' In September 2011, St Jude Medical Inc. became the first company to receive European approval for the use of PNS in treating chronic migraine. Appropriate candidates for PNS of the occipital nerves for the treatment of chronic migraine must be diagnosed with chronic migraine which is classified as intractable. Chronic migraine is defined by the International Headache Society (IHS) guidelines: Intractable chronic migraine is generally defined as chronic migraine with failure of three or more preventive drugs and at least moderate disability determined using a validated migraine disability instrument (e.g. MIDAS or HIT-6).