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Published on: September 13, 2024
Occipital Nerve Stimulation for Migraine: A Systematic Review
Yuecheng Yang1, Mingmin Song2, Yinghui Fan1
1Pain Management Center and Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Abstract:
Patients who suffer from migraines often report impaired quality of life. Occipital nerve stimulation (ONS) is a novel treatment modality for migraines, although few systematic reviews have evaluated whether this therapy is efficacious. The objective of this study was to evaluate the clinical efficacy and safety of ONS for treating migraine through a literature review. We performed a literature search to identify studies that investigated ONS for migraine treatment. Evidence levels of these studies were assessed by recommendations set by the University of Oxford Centre for Evidence-Based Medicine. Five randomized controlled trials, 4 retrospective studies, and one prospective study met the inclusion criteria. Results from the retrospective studies and case series indicated that ONS significantly reduced the pain intensity and the number of days with headache in patients with migraine. However, the evidence of ONS efficacy established by randomized controlled trials was limited. Improvement in the migraine disability assessment (MIDAS) score was more dramatic than improvement in the SF-36 score at follow-up. The mean complication incidence of ONS was 66% for the reviewed studies. Future clinical studies should optimize and standardize the ONS intervention process and identify the relationship among the surgical process, efficacy, and complications resulting from the procedure.
Insights
Occipital nerve stimulation (ONS) shows promise in reducing migraine pain and headache days, but robust evidence from randomized controlled trials is limited. Further research is needed to optimize this migraine treatment.
Area of Science:
- Neurology
- Neurosurgery
- Pain Management
Background:
- Migraines significantly impair patients' quality of life.
- Occipital nerve stimulation (ONS) is an emerging treatment for migraines.
- Limited systematic reviews exist on ONS efficacy for migraine.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of ONS for migraine treatment.
- To conduct a literature review of ONS in migraine therapy.
- To assess the evidence levels of included studies using the University of Oxford Centre for Evidence-Based Medicine recommendations.
Main Methods:
- Literature search for studies on ONS for migraine treatment.
- Inclusion of randomized controlled trials, retrospective studies, and prospective studies.
- Assessment of evidence levels based on established criteria.
Main Results:
- Retrospective studies and case series suggest ONS reduces pain intensity and headache frequency.
- Evidence for ONS efficacy from randomized controlled trials is currently limited.
- Significant improvements were observed in Migraine Disability Assessment (MIDAS) scores compared to SF-36 scores.
- The mean complication incidence for ONS was 66% across reviewed studies.
Conclusions:
- ONS demonstrates potential benefits for migraine patients, particularly in pain and frequency reduction.
- Further research is required to standardize ONS procedures and understand the relationship between surgical process, efficacy, and complications.
- High complication rates necessitate careful consideration and optimization of the ONS intervention process.
