• Rodrigo Garcia-Ortega, Tamara Edwards, Liz Moir, Tipu Z Aziz, Alexander L Green, and James J FitzGerald.
• Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
• Neuromodulation. 2019 Jul 1; 22 (5): 638644638-644.

BackgroundOccipital nerve stimulation (ONS) is widely used for headache syndromes including chronic migraine (CM) and chronic cluster headache (CCH). The paraesthesia associated with tonic stimulation can be bothersome and can limit therapy. It is now clear in spinal cord stimulation that paraesthesia-free waveforms can produce effective analgesia, but this has not been reported in ONS for CM or CCH.Materials And MethodsSeventeen patients (12 CM and 5 CCH) were treated with bilateral burst pattern ONS, including 4 who had previously had tonic ONS. Results were assessed in terms of the frequency of headaches (number of headache days per month for CM, and number of attacks per day for CCH) and their intensity on the numeric pain rating scale.ResultsBurst ONS produced a statistically significant mean reduction of 10.2 headache days per month in CM. In CCH, there were significant mean reductions in headache frequency (92%) and intensity (42%).ConclusionParaesthesia is not necessary for good quality analgesia in ONS. Larger studies will be required to determine whether the efficacies of the two stimulation modes differ. Burst ONS is imperceptible and therefore potentially amenable to robustly blinded clinical trials.© 2019 International Neuromodulation Society.

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