Occipital nerve stimulation substantially reduced chronic headache pain in patients unable to tolerate medical therapy, according to a study published in the November Lancet Neurology.
The six study subjects all suffered from hemicrania continua, a rare headache disorder in the form of a chronic daily headache for 15 or more days per month. The standard medical treatment for hemicrania continua is indomethacin, which can have serious gastrointestinal side effects.
Occipital nerve stimulation has been shown to be effective in the treatment of migraine and cluster headaches. A functional imaging study of migraine sufferers showed that occipital nerve stimulation activated areas involved in pain modulation. In the current study, researchers postulated that other primary headaches might also respond.
Participants had a bion, a small, rechargeable, battery-powered electrode, implanted near the occipital nerve at the back of the neck and set to give continuous signals at a frequency of 60 hertz (cycles per second) for three months. The bion was then turned off for the fourth month and switched back on at month five. Study participants recorded pain levels in daily diaries.
At long-term follow-up, four of the six patients experienced a substantial reduction in pain and one experienced a moderate pain reduction. Only one patient experienced an increase in pain.
“It’s quite exciting, because it’s a big paradigm shift in the way we think about treating patients with headache problems,” says lead author Peter Goadsby, although he acknowledges that it will be some years before headache sufferers will be able to ask their doctors for a bion implant.
Two placebo-controlled trials of occipital nerve stimulation for migraine are under way.