• James F Jiang, Ashley N Diaz, Melissa Campbell, Nicholas M Boulis, and Orion P Keifer.
• Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
• World Neurosurg. 2019 Apr 1; 124: e417e423e417-e423.

BackgroundPatients with refractory chronic primary headache disorders have extremely debilitating symptoms, severe comorbidities (e.g., anxiety, depression), and a significant reduction in quality of life. The headaches are extremely difficult to treat, as they are often refractory to pharmacologic and procedural interventions. Neuromodulation with stimulation of the occipital and supraorbital nerves has been proposed as a viable treatment for these refractory headaches. We retrospectively review the long-term (33.5 ± 20 months) results of supraorbital occipital nerve circumferential stimulation (SOCS) in patients with chronic primary headache disorders.MethodsWe retrospectively review 25 patients who were evaluated for SOCS for chronic primary headache disorders from 2010 to 2017 at a single institution with a single neurosurgeon.ResultsOf these 25 patients, 14 saw benefits to their trial stage of stimulation and underwent full implantation. A total 3 patients were excluded from further analysis because of having <2 months of follow-up or discordant data. Of the 11 patients analyzed, there was an overall response rate (≥50% pain reduction) of 82%. The average preoperative 10-point pain score dropped from 7.1 ± 1.6 to a postoperative score of 3.3 ± 2.1. However, there was a high rate of complications including infection, erosion, and loss of effect.ConclusionsThe results (82% response) suggest that SOCS may be an effective treatment and should be studied more extensively. Occipital nerve stimulation alone has shown 40% to 50% response rate in published studies. However, the relatively high complication rate highlights an obstacle for the approach for the treatment of refractory headache disorders and room for device optimization.Copyright © 2019 Elsevier Inc. All rights reserved.

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