How does Occipital Nerve Stimulation work?

In traditional occipital nerve stimulation, a thin wire containing electrodes is implanted under the skin in the back of the head.  The wire extends to an implantable battery-driven impulse generator (IPG).  Using a removable handheld programmer, the patient controls the rate and intensity of the pulses.  The pulses create paresthesias, which are often experienced as a light tingling or buzzing in the area of the occipital nerve and the distal branches of the second and third cervical nerves.  Although the mechanism is not entirely understood, peripheral neurostimulation may influence deep brain centers that are responsible for pain modulation, and may block pain signals from ascending pathways.

What are the possible risks of Occipital Nerve Stimulation, and what is being done to correct them?

In traditional occipital nerve stimulation, the IPG, which are typically as big as an Oreo cookie is implanted below the clavicle, in the flank, or in the lower abdomen.  The wires can thus extend more than a meter from the lead to the IPG, a situation that can lead to wire migration and breakage. Wire migration is one of the most common problems with occipital stimulation, but recently developed and still commercially unavailable microstimulators will eliminate that problem because the electrodes and IPG are contained within a stimulator device which is about the size of a paperclip.  The microstimulator will require less invasive surgery, hence carry fewer risks.  Traditional stimulators have long wires and require three incisions.  Microstimulators will require only one incision and no wires.

What kind of patients are good candidates for Occipital Nerve Stimulation?

Occipital nerve stimulation is for patients who have chronic daily headaches, have had continued severe headaches for years, and have tried everything, including multiple types of medications, as well as psychological, behavioral, and alternative approaches to pain management without success.  Typically, 75% of the patients treated with occipital nerve stimulation who have medically refractory chronic cluster headaches have a positive response three months after the implant.

What kind of complications can arise from Occipital Nerve Stimulation, and what can be done to mitigate them?

Occipital nerve stimulation complications can include infection, an increase in pain, and allergic reaction to the foreign material.  Traditional occipital nerve stimulation is first conducted on a trial basis to screen for increased pain.  Because occipital nerve stimulation takes time to work, the patient may not experience improvement in the five to seven day trial period.  As long as they have no adverse effects and are amenable, they can receive the device after the trial period.

Will my insurance company cover the cost of Occipital Nerve Stimulation?

Most patients will not be able to receive this device as almost all insurance companies will incorrectly consider this occipitally placed stimulation experimental. You will need to consult with your insurance company for clarifications.

2. For Traumatic Brain Injury and Post-Concussive Headaches

What do Traumatic Brain Injuries have to do with Post-Concussive Syndrome?

For unknown reasons, five-to-ten percent of people who experience Traumatic Brain Injuries have symptoms that extend beyond six weeks. These people are diagnosed with Post-Concussive Syndrome (PCS).

What are some of the symptoms of Post-Concussive Syndrome?

Some of the possible symptoms of Post-Concussive Syndrome are: Headaches, Dizziness or Lightheadedness, Vertigo, Ringing in the Ears or Hearing Impairment, Loss of Appetite, Sensitivity to Noise and/or Light, Anxiety, Irritability, Depression, Problems with Sleeping (such as being tired all the time or not being able to sleep), Nausea or Vomiting, Confusion, Memory Problems, Slower Intellectual processing Speed, Slurred Speech, Blurred and/or Double Vision, Decreased Sense of Smell and/or Taste, Lack of Balance and Coordination, Alcoholic Beverage Intolerance, Personality Changes, and Decreased Sex Drive.

Are there currently any proven-succesful treatments for PCS?

Unfortunately, there are no current proven-successful treatments for PCS.

Are any treatments currently being studied for use in treating PCS?

Preliminary testing was done by Kravitz, Ph. D and Thimeneur, MD. on the effectiveness of Occipital Nerve Stimulation on TBI patients, and the results were published as "The effect of Occipital Stimulation on Cognitive Function in Mild TBI." The results of the study showed that both headache relief and neuropsychological tests showed significant improvement on the TBI patients after Occipital Stimulation treatments.

Based on this research and the creation of Advanced Neuromodulation Systems (ANS), SLJ will be performing a Phase 1 Pilot Study to test the feasibility and efficacy of C2-C3 dermatomal Peripheral Nerve Stimulation on symptoms due to traumatic brain injury. This will be a single-center study at Scripps La Jolla for 6 months, studying between six-to-ten patients suffering from moderate TBI.