• Collin Clarke, Parinaz Azari, and Billy Huh.
• Department of Anesthesiology, Division of Pain Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA. cclarke@uwo.ca
• Neuromodulation. 2011 Nov 1;14(6):539-40; discussion 541.

IntroductionThe use of occipital nerve stimulators for the treatment of migraines has recently been suggested. However, there have been reports of complications, including lead migration causing local muscle stimulation and spasm with local burning sensation and loss of successful neuromodulation.CaseWe report a case of a patient who had successful permanent implantation and then presented with suspicion of lead migration. Upon examination of the lead at time of repositioning it was found that the insulation had eroded and the conducting wires exposed at the anchor site.DiscussionDisruption of occipital nerve stimulator lead insulation may mimic lead migration with failure of neuromodulation, spasm, and local burning sensations. Prior to reimplanting, a lead should be thoroughly inspected to ensure there is no mechanical failure. Anchoring should be performed with gentle direct suturing or the use of a protective anchoring device.© 2011 International Neuromodulation Society.

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