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Clinical utility of implantable neurostimulation devices in the treatment of chronic migraine

Authors Freeman JA, Trentman TL

Received 27 April 2013

Accepted for publication 20 August 2013

Published 20 November 2013 Volume 2013:6 Pages 195—201


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

John A Freeman, Terrance L Trentman

Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA

Abstract: Chronic migraine is a disabling disorder that is costly to individuals and society. Occipital nerve stimulation has been used to treat refractory cases of primary headache disorders including drug-resistant chronic cluster headaches and chronic migraine. The Food and Drug Administration (FDA) off-labeled application of equipment used for peripheral nerve (occipital) stimulation is borrowed from FDA-labeled spinal cord stimulation. Manufacturer-sponsored randomized trials include a feasibility study (ONSTIM-Medtronic) and a safety and efficacy study (St Jude). A non-industry sponsored prospective, randomized crossover study by Serra and Marchiotretto suggests improved quality of life and a significant reduction in medication use. Though preliminary studies suggest occipital nerve stimulation is safe and efficacious in treating chronic migraine headache, complication rates, including lead migration, lead fracture, and surgical site infections remain high. Further studies are needed to demonstrate long-term outcomes, while improved surgical techniques and site-specific equipment are needed to minimize complications.

Keywords: headache, occipital nerve stimulation, peripheral nerve stimulation, neuromodulation, electrical stimulation therapy

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