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Headache-Adviser Newsletter, Issue #22 Occipital Stimulation For Headaches
February 18, 2010

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Occipital Stimulation For Headaches

I have some exciting newer news about treatment of migraines and cluster headaches.

As we start to approach the spring months, cluster headaches will start to arise and those with chronic cluster headaches will suffer even more. Many times I will treat with starting verapamil once or twice day dosing, plus steroid for a week or two to break the headaches.

But what happens when nothing works?

Occipital Nerve Blocks

The feeling at the present time, is that if a patient has failed on numerous medications and even botox for migraine headache then that person should consider occipital nerve blocks or stimulators.

The first step is an occipital nerve block. So what is that? Well it is similar to other nerve blocks. A small amount of steroid is mixed with a numbing agent, such as lidocaine, and injected around the nerve.

The occipital nerves run up the back of your head, just under the skin. The method is important as blocking these nerves has been shown in headache research over the last few years, to feedback into the brain and dampen headache pain.

If you are currently under a neurologist's care, this is an easy procedure that can be done in the office. You might want to discuss this with your doctor on the next visit.

So what does the nerve block have to do with the occipital stimulator? If you respond to the block, but then it wears off and the headaches return, you might be a good candidate for a stimulator.

Occipital Stimulator For Headaches

As mentioned above, this procedure is quickly becoming a method to treat refractory headache patients. It has been investigated for several years, and trials were conducted at several headache centers across the United States in 2007 and 2008. At the International Headache Society Meeting in Philadelphia, Sept 2009, results were presented.

Occipital stimulation seems to be effective in approximately 67% of chronic cluster headache patients and about 48% of migraineurs.

This procedure is not generally done by neurologists, but usually done in conjunction with a neurologist and pain management specialist working together. Pain management doctors are usually anesthesiologists who are now in private practice, not working in hospitals. As a result they have OR experience and these stimulators are inserted in the OR under sterile conditions.

But first you must have a trial stimulator outside the skin to see if it will be as effective as the nerve block. If it is, then you qualify for the actual stimulator.

For the full procedure, the stimulator leads are inserted under the skin near the nerve on both sides of the head. The newer leads are extremely small (I held one in my hands the other night) and are quite flexible.

At the present time, two companies are making the stimulators, Medtronics and Boston Scientific. The battery for the Boston Scientific seems to be better as it holds a charge much longer and is smaller.

How Do I Find Out About This?

First of all, start with your neurologist and ask for the nerve block. Then start talking to your doctor about the procedure. Be proactive and find out if he or she knows about any pain management doctors in your area doing the stimulators.

Don't just wait! You can always call a few pain management doctor offices and ask yourself if they are doing this.

Metronics and Boston Scientific are VERY hands on with these devices. They contact patients and walk them through alot of the necessary forms and procedure aspects. Many times the technical specialist for the company is in the OR during the procedure (with your permission). They also have a list of doctors in your area doing the prodcedure.

The official names for these devices are neurostimulators as they over stimulate nerves to deaden pain when used in the spine and can feedback to the brain for headaches.

Here is the Medtronics site neurostimulator information.

Here is the Boston Scientific site neurostimulator information.

Good luck, and remember there are always new research methods being developed for headache.

Here's To Headache Free Days

Take care..

Mary Kay Betz, MS RPA-C
Physician Assistant

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