Greater Occipital Nerve Stimulators and Intractable Migraine

Today marks a new point for Pacific Rim Headache Center, in that one of our patients is getting an occipital nerve stimulator for refractory chronic migraine.  She was the ideal candidate simply because she has exhausted all other treatments. She had been extremely compliant in treatments, tried a variety of approaches including virtually all the pharmacological and non pharmacological ones with only temporary benefit.  She also suffered tremendously.  I will ad links to this procedure at the end of this article so you can read more about it.  I just want to give a summary of where this treatment stands at this point.

The major impact of occipital (and other cranial nerve) stimulation is that, in limited studies, it appears to be quite effective in even the most refractory of cases.  All patients need hope and when they, like our patient, have exhausted all traditional treatments, there must be place they can turn to.

The other important part to this procedure is that it opens up a whole new avenue on headache treatment that may play a major role in the future.  By adding a little electricity to the malfunctioning nerves that cause the problem of headache, it appears that you can switch them off.

There are several down sides to this procedure. First of all, it is invasive.  It requires a skill neurosurgeon to place the electrodes securely on the Greater Occipital Nerve, at the back of the head.  Then you have to run the leads under the skin to a safe location for the small computer that sends the electrical pulses.  This is usually on the chest. In the studies, while the benefits have been profound for some, there have been many complications such as infections to the surgical wound and the leads coming off over time.

The other hesitation with the procedure, even though it has been around for decades in some form or another, the research is still quite limited. The studies have been limited to small groups of patients and for limited times, such as a year or less.  Long term studies are pending.

Lastly, it is difficult for financial reasons.  The hardware is not cheap. Neurosurgeons are certainly not cheap and not that many are trained in the procedure (nor interested). Because it is still considered experimental, most insurances don’t pay for it.  Therefore there is little financial motivation for neurosurgeons to do the procedure.  Headache work, in general, is not a money maker for anyone and that is why there are so few headache clinics.

It took us six months to create a relationship with a group that did do the procedure, and that search was nationwide. Most don’t do it because it isn’t cost effective for them. Once we found a group that we could partner with, in Salem, OR, we fought hard with our patient’s insurer.  We had to give powerful arguments to persuade them to invest in this patient’s wellness with a controversial procedure.  They did agree to pay the, almost $26,000 and I am grateful to them for understanding and Regence should be applauded from their honest concern.

For more information:

Here is an article by my old boss.

Here are some photos on the procedure.

Here is a decent description on Wikipedia.

Here is one patient’s personal story.