Safety and Efficacy of Occipital Nerves Stimulation for the Treatment of Chronic Migraines: Randomized, Double‐blind, Controlled Single‐center Experience

• Published in: Pain practice 2017-06, Vol.17 (5), p.669-677
• Main Authors: Mekhail, Nagy A., Estemalik, Emad, Azer, Gerges, Davis, Kristina, Tepper, Stuart J.
• Format: Article
• Language: English
• Subjects: Adult; causalgia; complex regional pain syndrome; Double-Blind Method; Electric Stimulation Therapy - methods; Female; Humans; Male; Middle Aged; Migraine Disorders - therapy; neuromodulation; Pain Management - methods; Peripheral Nerves - physiology; Quality of Life; reflex sympathetic dystrophy; spinal cord stimulation; Treatment Outcome
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.12504

Background A recent multicenter study presented 52‐week safety and efficacy results from an open‐label extension of a randomized, sham‐controlled trial for patients with chronic migraine (CM) undergoing peripheral nerve stimulation of the occipital nerves. We present the data from a single center of 20 patients enrolled at the Cleveland Clinic's Pain Management Department. Methods In this single center, 20 patients were implanted with a neurostimulation system, randomized to an active or control group for 12 weeks, and received open‐label treatment for an additional 40 weeks. Outcomes collected included number of headache days, pain intensity, Migraine Disability Assessment (MIDAS), Zung Pain and Distress (PAD), direct patient reports of headache pain relief, quality of life, satisfaction, and adverse events (AEs). Results Headache days per month were reduced by 8.51 (±9.81) days (P < 0.0001). The proportion of patients who achieved a 30% and 50% reduction in headache days and/or pain intensity was 60% and 35%, respectively. MIDAS and Zung PAD were reduced for all patients. Fifteen (75%) of the 20 patients at the site reported at least one AE. A total of 20 AEs were reported from the site. Conclusion Our results support the 12‐month efficacy of 20 CM patients receiving peripheral nerve stimulation of the occipital nerves in this single‐center trial.