Dedicated Lead for Occipital Nerve Stimulation for Treatment of Refractory Head Pain: Technical Note

Objective: Occipital nerve stimulation (ONS) has been used for many years for the treatment of refractory headache and head pain.Its effect has been documented in case series and cohort studies.The positive clinical benefits, however, have been accompanied by high complication rates, predominantly due to lead migration and breakage.We report our institutional experience with performing occipital nerve stimulation using a dedicated, custom made, ONS lead. Methods:We retrospectively reviewed the medical records of patients treated for their head pain with this dedicated ONS lead.Demographic information including age, gender, preoperative diagnosis, progression to permanent implant after a successful trial and technical complications, such as lead breakage and skin erosion, were collected.In addition, therapy outcomes such as pain relief, degree of satisfaction with the treatment and analgesic use were collected.Results: A total of 71 patients with refractory headache disorders were implanted with the custom made ONS leads.The majority of patients (65/71) had a successful percutaneous trial and proceeded to implant of the neurostimulator.The procedure was well tolerated by the patients and no lead migrations and skin erosions occurred during the 28 months (range 0-58) follow-up.Two patients had an infection and in three patients the system was explanted due to lack of longterm benefit. Conclusions:The use of the dedicated ONS lead provides a safe and stable clinical solution for occipital nerve stimulation in patients with refractory head pain.