Occipital Nerve Stimulation for Intractable Occipital Neuralgia

Occipital nerve stimulation for chronic migraine: A randomized trial on subthreshold stimulation

“…But the lack of standard surgical technique, standard stimulation parameters and accepted guidelines for patient selection impedes comparison between studies, resulting in many unsolved questions (2)(3)(4)(5)(6)(7)(8).…”

Surgical treatment of primary headaches

“…The surgical technique has been described by our group in a previous manuscript [23] and briefly consists of anchoring the plastic tip of each positioned electrode to the underlying muscular fascia with non-adsorbable sutures and of tunnelling the connection cables to the subcostal region, where the internal pulse generators (IPGs) are placed. Clinical indications to ONS are: CCH [24], hemicrania continua [25], transformed migraine [26,27], cervicogenic headaches [28] and occipital neuralgia [29,30]. Apart from the latter two indications, the use of ONS for the different types of cranial neuralgias is justified by the presence of a functional unit known as the ''trigemino-cervical complex'', which comprises the trigeminal nucleus caudalis and the first two cervical spinal myelomeres and in which nociceptive informations of both the suboccipital and trigeminal territory converge, thus stimulation of the greater occipital nerve could modulate the central nociceptive trigeminal neurons through peripheral cervical afferents [31].…”

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

“…C1 lateral mass screws have been reported as being an iatrogenic cause of such a syndrome also, and needs to be considered in the post-operative period (Conroy et al 2010). The use of nerve stimulators have been associated with a mean reduction of 96% on the visual analogue score (Magown et al 2009), and are the treatment of choice in our institution (in the absence of atlantoaxial instability) post-successful diagnostic occipital nerve blocks.…”