• Stephen D Silberstein, David W Dodick, Joel Saper, Billy Huh, Konstantin V Slavin, Ashwini Sharan, Ken Reed, Samer Narouze, Alon Mogilner, Jerome Goldstein, Terrence Trentman, Julien Vaisman, Julien Vaisma, Joseph Ordia, Peter Weber, Timothy Deer, Robert Levy, Roni L Diaz, Stephanie N Washburn, and Nagy Mekhail.
• Thomas Jefferson University, Philadelphia, PA, USA. stephen.silberstein@jefferson.edu
• Cephalalgia. 2012 Dec 1;32(16):1165-79.

BackgroundChronic migraine (CM) is a debilitating neurological disorder with few treatment options. Peripheral nerve stimulation (PNS) of the occipital nerves is a potentially promising therapy for CM patients.MethodsIn this randomized, controlled multicenter study, patients diagnosed with CM were implanted with a neurostimulation device near the occipital nerves and randomized 2:1 to active (n = 105) or sham (n = 52) stimulation. The primary endpoint was a difference in the percentage of responders (defined as patients that achieved a ≥50% reduction in mean daily visual analog scale scores) in each group at 12 weeks.ResultsThere was not a significant difference in the percentage of responders in the Active compared with the Control group (95% lower confidence bound (LCB) of -0.06; p = 0.55). However, there was a significant difference in the percentage of patients that achieved a 30% reduction (p = 0.01). Importantly, compared with sham-treated patients, there were also significant differences in reduction of number of headache days (Active Group = 6.1, baseline = 22.4; Control Group = 3.0, baseline = 20.1; p = 0.008), migraine-related disability (p = 0.001) and direct reports of pain relief (p = 0.001). The most common adverse event was persistent implant site pain.ConclusionAlthough this study failed to meet its primary endpoint, this is the first large-scale study of PNS of the occipital nerves in CM patients that showed significant reductions in pain, headache days, and migraine-related disability. Additional controlled studies using endpoints that have recently been identified and accepted as clinically meaningful are warranted in this highly disabled patient population with a large unmet medical need.Trial RegistrationClinical trials.gov (NCT00615342).

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