Occipital nerve stimulation for head pain: Surgical leads

Abstract

Over the last 15 years, occipital nerve stimulation (ONS) has become one of the most commonly used neuromodulation procedures. Its indications today include occipital neuralgia, cervicogenic headaches, transformed migraines, cluster headaches, and even fibromyalgia. Most of the time, the ONS procedure involves percutaneous insertion of wirelike electrode leads but for a variety of reasons, this approach is plagued with a high rate of reoperation for migration. Some of these issues may be overcome by the use of surgical (paddle-like) electrode leads that provide unidirectional stimulation and are associated with lower migration rates. In this chapter, we review the current state of surgical lead use in ONS and discuss benefits and shortcomings of this choice of stimulation hardware.