Occipital Nerve Stimulation may ease Refractory Chronic Migraine

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Occipital Nerve Stimulation may ease Refractory Chronic Migraine

According to a latest study, occipital nerve stimulation. Worldwide, almost 4% of the population is affected by refractory chronic migraine causing severe pain, lifestyle limitations and poor quality of life. The electrical stimulation of the distal branches of greater and lesser occipital nerves is known as the occipital nerve stimulation (ONS). This method has been well explained and had revealed efficacy in the headache disorder treatment. The long-term efficacy and tolerability of ONS for a medically intractable chronic migraine had been assessed in this prospective, long-term, open-label and uncontrolled observational study.

The patients meeting the International Headache Society criteria for a chronic migraine who were previously treated with other therapeutic alternatives and who met all inclusion and exclusion criteria for neurostimulation were considered for this study. They received the implantation of an ONS system after a positive psychological examination and a positive response to a preliminary occipital nerve blockage. This implantation was carried out in two stages: a 10 day trial with implanted occipital leads attached to an external stimulator and, if more than 50% pain relief was obtained, permanent pulse generator implantation and connection to the formerly implanted leads. An in-depth analysis of the patients after the surgery annually via different scales like pain Visual Analogue Scale (VAS), number of migraine attacks per month, sleep quality, functionality in social and labor activities, reduction in pain medication, patient satisfaction, tolerability and reasons for termination was done. Thirty-one patients with an average follow-up time- 9.4±6.1 years fulfilled a 7-year follow-up period.

Overall, 37 patients were registered for the study. They were grouped as per the location and quality of their pain, accompanying symptoms, work status and psychological outcomes. In most patients, a substantial pain reduction was obtained and the VAS reduced by 4.9 ± 2.0 points. The results were steady over the follow-up period. Out of 35 patients, 5 permanently implanted patients with migraine attacks at baseline were free from these attacks at their last visits and the pain severity lessened 3.8 ± 2.5 (according to the VAS) in the remaining patients. Out of 35 patients, 7 implanted devices were definitively detached: 2 devices due to treatment inefficacy and 5 devices as the patients were asymptomatic and considered to be cured of their pain, even with the stimulation off. No systemic side effects were observed.

The uncontrolled, open-label design along with failure to complete the 7-year follow-up period serves as a limitation for this study. It was contemplated that the trigemino-cervical autonomous and cervical connection may explain why ONS might ease chronic migraine pain, but this was just a theoretical explanation which should be exhibited in future studies. These consequences were a little superior to previous reports and were sustained over the 7-year follow-up. An efficient selection of patients, realization of diagnostic occipital nerve blocks, psychological evaluations, rigorous surgical method and suitable parameter programming, rendered these outcomes.


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The original title of the article:

Occipital Nerve Stimulation for Refractory Chronic Migraine

Therapeutic, Occipital nerve stimulation (ONS), Refractory chronic Migraine, Occipital nerve, Uncontrolled, Open-label design, Efficacy, Tolerability,Visual Analogue Scale (VAS)
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