• Sylvie Raoul, Jean Michel Nguyen, Emmanuelle Kuhn, Edwige de Chauvigny, Sarah Lejczak, Jean-Paul Nguyen, and Julien Nizard.
• Neurosurgery Department, UIC22, University Hospital, Nantes, France.
• Neuromodulation. 2020 Aug 1; 23 (6): 789-795.

BackgroundOccipital nerve stimulation (ONS) is shown to be effective in treating various forms of headache. Most studies describe the treatment of occipital neuralgia (ON), but in many patients, the clinical description could also correspond to cervicogenic headache (CGH) or occipital migraine (OM). These different entities (ON, CGH, and OM) may be grouped together under the term occipital headaches.ObjectiveTo assess the efficacy of ONS to treat occipital headaches in a large series of patients with a long-term follow-up.Materials And MethodsWe performed a retrospective review of data on 60 patients with intractable occipital headaches treated with occipital nerve stimulation (ONS), who were referred to our center between October 2008 and October 2014. Details of pain evaluation, location, duration, cause and previous treatment were analyzed. Evaluations included the visual analog scale (VAS), the number of headache days per month (NHD), and the Medication Quantification Scale (MQS). Trials with transcutaneous electrical nerve stimulation (TENS-ONS) were performed and served as a guide for surgery indication (see Patients and Method section).ResultsAfter one year of ONS, mean VAS had decreased from 8.4/10 to 2.8/10 (72.2% reduction [p < 0.001]), and 76% of patients had at least a 50% decrease in mean VAS score. The mean MQS score decreased from 18 to 8.8, corresponding to a reduction of pain medication by an average of 50%. Adverse events concerned 12 patients (20%). Six patients presented with electrode displacement or fracture (10%) and six patients presented with cases of infection (10%) associated with the pulse generator.ConclusionsThe results of this large series confirm that ONS is an effective treatment option for patients with intractable occipital headaches, but the frequency of complications remains quite high and must be taken into account in the surgical decision.© 2020 International Neuromodulation Society.

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