Occipital Nerve Stimulation

Note: Although occipital nerve stimulation has decades of evidence and in my experience is safe and effective, very few insurance plans cover the procedure. As a result, I am not currently accepting occipital nerve stimulation referrals unless a patient is willing to pay out-of-pocket for the procedure.

Occipital nerve stimulation is a procedure used to treat occipital neuralgia and other headache disorders such as SUNA/SUNCT, chronic migraine, and cluster headache. In the procedure, thin wires are inserted beneath the skin of the back of the head in the location of the occipital nerves. The wires are connected to a battery that provides electrical pulses to disrupt pain signals from the nerves.

Occipital nerve stimulation is performed in two stages, neither of which requires a hospital stay. The first stage is referred to as a stimulator trial. I use a needle to insert temporary wires that come out through the skin and are connected to an external battery pack. The patient tries the stimulator for 1-2 weeks to determine whether it provides pain relief. The wires are then pulled out in my office.

If a patient has benefit from the trial stimulator, I implant a permanent stimulator in a second procedure. The permanent system sits entirely under the skin. The wires at the back of the head are connected to a small battery implanted under the skin beneath the collarbone, similar to a heart pacemaker.

Occipital nerve stimulation can be very effective for the right patient. It is minimally invasive and does not involve any procedure on the brain or spinal cord. The main risks are infection of the device and a wearing off of pain relief over time. I choose patients very carefully for this procedure, and part of the evaluation includes a meeting with a pain psychologist.