Peripheral Nerve Stimulation for Occipital Neuralgia: A Parallel Approach

Occipital neuralgia (ON) is a common headache syndrome characterized by sharp, shooting pain affecting the posterior head in the distribution of the occipital nerve. It is associated with debilitating symptoms that can severely impact a patient's quality of life. We report the use of peripheral nerve stimulation (PNS) for ON with a nonconventional, parallel technique.

A patient in their late 20s presented with persistent headaches and ON after a posterior occipitocervical fusion secondary to a C2 burst fracture because of a motor vehicle accident. Multiple modalities for pain treatment were tried without relief. Patient was considered a candidate for PNS. The patient first underwent a trial implantation. Using ultrasound and fluoroscopy, an 8-lead, Curonix stimulator lead was placed parallel to the nerve, entry from caudal to cranial. At follow-up, the patient reported nearly 100% pain relief. Patient proceeded with a 4-tined leads permanent PNS implant. Patient reported near absence of pain at 3-month, 6-month, and one-year follow-ups.

We demonstrate a unique approach of peripheral nerve implantation for the treatment of ON, specifically with the stimulator lead parallel vs commonly used perpendicular to the occipital nerve. This case demonstrates why a parallel technique may be a feasible method with better outcomes.