Occipital Nerve Stimulation of Interest To Migraine Sufferers

By  //  July 15, 2012

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PAIN MANAGEMENT

ARTICLE COURTESY OF SPACE COAST MEDICINE MAGAZINE

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.

OCCIPITAL NERVE STIMULATION 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. (Shutterstock image)

Although ONS was first used for migraines in 1977, it is still a treatment in development. The first clinical trial data has now been released, shedding some light on how well the treatment works and what may lie ahead.

As a Neurostimulator implanter, I have been involved with the St. Jude Medical Neuromodulation division performing research on many patients suffering with various pain conditions that benefit from Neurostimulator devices.

Occipital Nerve Stimulation

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.

THANKS TO ONS THERAPY, Sharon Davis, above with Dr. Stan Golovac, now lives a healthy life, free of daily headaches that caused her grief, loss of work and emotional distress. (Florida Pain image)

The basic hardware of the ONS systems consists of a lead with electrodes and contacts that are connected to a separately implanted impulse generator by a wire. Surgical procedures for ONS vary, but in general, a small device is implanted at the base of the skull — near the occipital nerve. The device is then connected to a power source that sends electrical impulses to the occipital nerve.

Over the past six years, ONS 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 headaches, and chronic hemi-continua have been reported.

The favorable results from these preliminary open studies have prompted three randomized, sham-controlled studies in patients with refractory chronic migraine. Results from these studies are anxiously awaited and expected over the next 24 months.

Thin lead wires are placed under the skin near the occipital nerves, which arise from the spinal cord and branch out across the back of the head carrying sensory signals from that region to the brain. The leads are connected to an implanted Medtronic neurostimulator that delivers controlled electrical pulses to the occipital nerves.

Patients In the Study Receive Either:

• A neurostimulator and have the ability to control the level of stimulation;
• A neurostimulator as part of a device control group;
• Only standard medical management instead of an ONS implant.

Over the past six years, ONS has emerged as a potential treatment option for a variety of different intractable primary headache disorders.

A positive response was defined as at least a 50 percent reduction in the number of headache days in a month, or a reduction in the pain intensity of at least three points on a standard 0-10 pain scale. Slippage of lead wires was the most common adverse event.

As Founder of Florida Pain, I have implanted many of these devices like the one that Mrs. Sharon Davis has. At 64 years old, she now lives a healthy life free of daily headaches that caused her grief, loss of work, and emotional distress.

Clinical Trial Was Designed To Follow Patients

In addition to evaluating the efficacy of ONS therapy, the clinical trial was designed to follow patients for up to three years related to safety. The results suggest that ONS is a promising therapy option for individuals who have not had success in treating their chronic migraine medically, and as a result are living with the painful and often debilitating symptoms.

Over the past six years, ONS has emerged as a potential treatment option for a variety of different intractable primary headache disorders.

While ONS for chronic migraine requires additional clinical evaluation, our early experience with this study is encouraging and indicates that ONS could possibly help some chronic migraine patients who have exhausted other treatment options. Additional ONS studies are ongoing, and their results are anxiously awaited.

Key Points For Patients To Considering

• ONS is not appropriate for all patients.
• Occipital nerve block injections may be a good predictor of whether ONS is suitable for individual patients.
• ONS is not yet FDA-approved for migraine and headache prevention, but may be prescribed off-label (as many medications are).
• Since ONS is not FDA approved, most insurance companies will not pay for this treatment.

FLORIDA PAIN TESTIMONIAL: "We have been patients here for many years and feel we have always received exemplary medical care. Not only top-notch professional care, but kind and compassionate care. This practice is complete - you are taken care of from A-Z...office visit, pharmacy, physical therapy and surgery center. We highly recommend this center." - Joseph & Sheila M.

A word of caution here – coding insurance forms for conditions other than migraine or headache in order to get insurance company approval and payment is an illegal practice that could result in patients having an additional condition (that they don’t have) listed on their medical records, and action taken against any provider using fraudulent coding. If ONS is approved based on a condition the patient does not have, insurance companies can rescind payment and/or take legal action.

It should also be noted that, although there’s evidence that ONS can be effective in the treatment of chronic headache disorders, more studies are needed before the approach can be considered a routine headache treatment, and contrary to the sensationalized headlines coming from some mainstream media outlets, ONS is not a cure for migraine disease.

It can be an effective preventive treatment for some patients, but it addresses only some migraine triggers, not all. Thus, patients using ONS may see a reduction in migraine and headache frequency, but not a complete cessation of migraines and headaches.

To contact Dr. Golovac call 321-784-8211 or log on to FloridaPain.net

Florida Pain Doctor, Stanley Golovac, MD

Dr. Stanley Golovac completed his education at UTESA University in 1985, where he received his Doctor of Medicine. Upon graduation, Dr. Golovac completed his postgraduate training in Family Practice Residency Program at St. Mary Hospital in New Jersey and in the Department of Anesthesiology at Jackson Memorial Hospital in Miami.

Dr. Golovac

Dr. Golovac gained extensive clinical experience in anesthesiology, emergency room medicine, and alternative services. He served as Assistant Clinical Professor of Anesthesia at the University of Miami Jackson Memorial Center for several years, and then as a practicing Pain Consultant in the Miami area. He currently utilizes his expertise at Florida Pain, Merritt Island Surgical Center and Space Coast Surgery Center (located at our facility).

Dr. Golovac is a Diplomat of the American Board of Anesthesiology and the Board of Pain Management. He is certified by the Educational Commission of Foreign Medical Graduates, Federal License Examination and in Basic Life Support and Advanced Cardiac Life Support. He is a member of the American Academy of Pain Management, International Anesthesia Research Society, American Society of Anesthesiologists, and Florida Society of Anesthesiologists.

Dr. Golovac is also a member of the American Medical Association, and a current recipient of the AMA Physician’s Recognition Award Certificate (AMA PRA). This certificate recognizes physicians who complete at least fifty hours of continuing medical education annually.

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