Occipital nerve stimulation (ONS) for intractable chronic migraine

Occipital nerve stimulation (ONS) for intractable chronic migraine is usually done in 2 stages, although a single-stage procedure is sometimes used

• in the first, trial stage, using local anaesthesia and usually with fluoroscopic guidance, electrodes are passed through a subcutaneous tunnel and placed over the occipital nerve(s) around the level of C1
  • correct placement of electrodes is verified by intraoperative stimulation and patient feedback before they are sutured to subcutaneous tissue
  • a lead is tunnelled under the skin from the electrode to an exit site in the posterior cervical region, where it is connected by an external extension lead to a hand-held neurostimulator
    
    
• the second stage is carried out if the trial is successful
  • with the patient under general anaesthesia, an implantable neurostimulator is secured in a subcutaneous pocket, usually in the infraclavicular region or the abdominal wall
  • a lead is tunnelled from the electrode to the implantable neurostimulator. The patient uses a remote control to stimulate the occipital nerves when needed

NICE suggest that "..evidence on occipital nerve stimulation (ONS) for intractable chronic migraine shows some efficacy in the short term but there is very little evidence about long-term outcomes. With regard to safety, there is a risk of complications, needing further surgery. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.."

Reference:

• NICE (April 2013). Occipital nerve stimulation for intractable chronic migraine