Occipital Nerve Stimulation for Migraine

Mumbai, October 17, 2008: Jaslok Hospital & Research Centre has conducted a novel surgery for the treatment of Migraine by Stimulation of the Greater Occipital Nerve (GON). This is the first time in India that such a surgery has been conducted. This was conducted by Dr Paresh Doshi, Functional Neurosurgeon and Dr. K Ravishankar, Headache specialist at Jaslok Hospital.

Migraine – a form of chronic debilitating malady characterized by recurrent throbbing headache, lasting anywhere from 4-24 hours, associated with photophobia and phonophobia, occurs in 70% of patients suffering from chronic headaches. In the general population the incidence of this varies from 15-18% in females, 6% in males and 4-6% in children. Most of these headaches respond to conservative treatment, however, some of them cannot be controlled (approx 4%) with all the available options. This are labeled as intractable migraineurs.

Mr. TL, 42 yrs old male had been suffering from Migraine for last 11 years. For past 4-5 years it had become intractable. He experienced attacks for 15-20 days in a month, sometimes on the left and sometimes on the right. There could be multiple attacks during the day leaving him significantly disabled for 8-10 hours. Apart from medical treatment, he had also tried Botulinum Toxin treatment without much benefit.

As his work was significantly affected by his disease condition, he agreed to undergo Occipital Nerve (ON) stimulation procedure.  As this patient qualified for ON stimulation, we went ahead and implanted two eight contact point electrodes in this patient overlying the GON. They have been connected to a pacemaker implanted on the chest wall. The pacemaker delivers current to stimulate the GON through the electrodes.  Whenever the patient gets a Migraine attack he can switch on the pacemaker and control his migraine.

At our institute, patients are selected by the specialist as per the International Headache Society guidelines and criteria to undergo this treatment.  It has been now two years and the patient has been off drugs for the past week and has not suffered any lasting Migraine attacks.  For one year he has not been on any medications or has not even required to use the pacemaker.

The Occipital Nerve arises at the back of the head and supplies sensation to the back of the head. (Fig 1). There are two Greater Occipital Nerves, Right and Left. These nerves have connections in the brain with an area called trigeminovascular (TVS) complex, which is involved in pain generation felt in Migraine. It was noted by Dr. Dodick and Dr. Godsby that stimulation of GON can alter the chemical balance in this TVS complex and help to control the migraine.

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