Peripheral neuromodulation for treatment of chronic migraine headache

Chronic migraines (CM) affect approximately 2% of the population, resulting in significant disability, economic burden, and impairments in quality of life. Historical neurosurgical procedures, such as lesioning of the trigeminal dorsal root entry zone or neurolysis of the occipital nerve, have not gained favor because of procedural morbidity and poor durability, respectively. Occipital nerve stimulation is emerging as a potentially promising modality for the treatment of CM, with greater than 50% pain reduction in approximately 80% of patients in open-label trials and ∼40% of patients in randomized controlled trials. Mechanisms of neuromodulation remain unclear.