Occipital nerve stimulation (ONS) in the treatment of chronic migraines

Recently more and more emphasis has been put on the possibilities opened up by peripheral nerve stimulation (PNS). It provides a good opportunity for patients who are suffering a lot of pain. Patients with all types of pain (in the head, back, neck, arms and legs) can be treated successfully. Due to increasing progress in microelectronics it is possible to implant an appliance similar to a pacemaker under the skin, enabling continuous neuromodulation. The appliance is roughly the size of a matchbox.


For the treatment of chronic migraines a special rechargeable system can be implanted, omitting the need for a change of battery. It is also possible to have a non rechargeable appliance, whose battery can be exchanged after a few years.  The stimulator sends electrical signals to the occipital nerve (ON), which is situated directly under the skin in the nape of the neck. Due to this specific localisation, this treatment is called Occipital Nerve Stimulation (ONS).


The effect of Occipital Nerve Stimulation is explained through changes in the electric regulation of the brainstem. The pattern of pain signals is modulated and overlaid through continuous stimulation. The constant oversensitivity in the nervous system is smoothed out and reduced. The function of the neurostimulator system and peripheral nerve stimulation can be compared to that of the pacemaker. It is assumed that the body’s own pain resistance is activated and stabilised through neuromodulation and thus sensitivity to pain can be reduced in a natural way.


If the treatment is to be successful, it is necessary that a diagnostic evaluation is carried out by a neurologist who specialises in migraines and headaches, or by a specialised centre. Our practice cooperates with the pain clinic in Kiel www.schmerzklinik.de to ensure that patients are suitable for this type of treatment. In the context of this study I operate on patients with migraines who are treated at the clinic in Kiel. This guarantees the highest possible safety for the patients with respect to the diagnosis and consultation, as well as care before and after the treatment.

Chronic migraines are a particularly progressive form of migraine. The affected patients suffer from bad headaches on more than 15 days a month. They have suffered with headaches for this number of days per month for at least three months. An overdose of medication is not the case, so with chronic migraines there is a high frequency of spontaneous attacks which cannot be solved by staying off the medication. The pains can also be localised in the area at the back of the head and shoulder/neck area. Preventive medicine is not effective despite sufficient dosage and good length of course. All steps taken in the treatment showed no sustained improvement.

For an initial consultation and information please contact Mrs Bettina Frank. bfrank@neurochirurgie-drfrank.de.

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