Peripheral Nerve Stimulation of C2-C3 Nerves for Management of Headaches: A Description of a Novel Technique

Chronic headaches and occipital neuralgia are important yet frequently underrecognized causes of head and upper cervical pain. This review describes a peripheral nerve stimulation (PNS) technique targeting the C2-C3 nerves for the management of refractory headache disorders and highlights key anatomical considerations to improve procedural accuracy.

Peripheral nerve stimulation of the occipital region has demonstrated efficacy in reducing pain associated with chronic headache disorders and occipital neuralgia. The described technique utilizes two Tuohy needles inserted in a caudal-to-cephalad trajectory, with lead placement adjacent to the C2 and C3 medial branches. Advances in wireless neuromodulation systems have reduced complications associated with implanted pulse generators, including infection, pocket pain, and the need for replacement procedures. Despite these improvements, technical challenges such as anatomic variability, lead migration, and lead dislodgement remain important considerations. PNS targeting the C2-C3 nerves represents a minimally invasive treatment option for patients with refractory chronic headaches and occipital neuralgia. Careful anatomical localization and confirmation of stimulation coverage are critical for optimizing outcomes and minimizing complications. Emerging wireless neuromodulation technologies may further improve the safety and practicality of occipital nerve stimulation in appropriately selected patients.