Occipital nerve stimulation for chronic migraine: a randomized trial

Pain Physician, 05/21/2012

According to the results obtained, occipital nerve stimulation (ONS) appears to be a safe and effective treatment for carefully selected chronic migraine (CM) and medication overuse headache (MOH) patients.

Methods

  • Eligible patients who responded to a stimulation trial underwent device implantation and were randomized to “Stimulation On” and “Stimulation Off” arms.
  • Patients crossed over after one month, or when their headaches worsened.
  • Stimulation was then switched On for all patients.
  • Disability as measured by the Migraine Disability Assessment (MIDAS), quality of life (SF–36), and drug intake (patient’s diary) were assessed over a one–year follow–up.

Results

  • 34 patients (76% women, 34% men, mean age: 46 ± 11 years) were enrolled; 30 were randomized and 29 completed the study.
  • Headache intensity and frequency were significantly lower in the On arm than in the Off arm (P < 0.05) and decreased from the baseline to each follow–up visit in all patients with Stimulation On (median MIDAS A and B scores: baseline = 70 and 8; one–year follow–up = 14 and 5, P < 0.001).
  • Quality of life significantly improved (P < 0.05) during the study.
  • Triptans and nonsteroidal anti–inflammatory drug use fell dramatically from the baseline (20 and 25.5 doses/month) to each follow–up visit (3 and 2 doses/month at one year, P < 0.001).
  • A total of 5 adverse events occurred: 2 infections and 3 lead migrations.

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