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Occipital Nerve Stimulation for Migraine and Headache Prevention - 2008 Update

by Teri Robert, Lead Expert

The use of occipital nerve stimulation (ONS) for the prevention of Migraines and headaches is in clinical trials and has been of great interest to those sufferers with intractable Migraines and headaches that do not respond well to treatment. The first clinical trial data has now been released, shedding some light on how well the treatment works and what may lie ahead.

Background:

What is occipital nerve stimulation (ONS)? ONS involves delivering a small electrical charge to the occipital nerve to prevent Migraines and headaches in patients who have not responded to medications. ONS is not effective for all patients, and a trial of occipital nerve block injections is often a good indicator of ONS suitability for specific patients.

The basic hardware of the ONS systems consists of a lead with electrodes and contacts which is connected to a separatelyimplanted impulse generator by a wire. 1

Dr. David Dodick has summarized the progress of ONS research to date (June, 2008):

"Over the past 6 years, occipital nerve stimulation has emerged as a potential treatment option for a variety of different intractable primary headache disorders...  Open-label prospective studies and case series evaluating the efficacy and safety of ONS in patients with medically refractory chronic migraine, chronic cluster headache, and hemicrania continua have been reported (refs). The favorable results from these preliminary open studies have prompted three randomized, sham-controlled studies in patients with refractory chronic migraine (PRISM NCT00286078 (Advanced Bionics), ONSTIM (Medtronic Inc.), Advanced Neurostimulation Systems). Results from these studies are anxiously awaited and expected over the next 24 months."1

Neurostimulation, including ONS, is not yet FDA approved for the treatment of Migraine disease or other headache disorders, but the clinical trials are progressing. The biggest of these clinical trials is the Occipital Nerve Stimulation for the Treatment of Intractable Migraine (ONSTIM) sponsored by Medtronic, which included patients who have regularly experienced 15 or more headache days per month that were not responsive to conventional medical therapies.

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