BOSTON — Occipital nerve stimulation was found to significantly reduce headache severity and frequency in a small study described in a poster presented at the American Academy of Physician Assistants Impact 2014 meeting.

Approximately 23% of adults and 5% to 10% of children complain of chronic recurring headaches, and many of these patients continue to suffer despite various treatments, Dawn LaBarbera, PhD, PA-C, of University of Saint Francis in Fort Wayne, Indiana, and colleagues reported here.

They sought to determine whether occipital nerve stimulation could reduce the frequency and severity of headaches among patients in a pain-management practice. Occipital nerve stimulation is a form of neuromodulation, in which electrical stimulation is employed to block pain signals.

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The study took the form of a retrospective chart review for 11 women and 6 men (mean age 44.8 years; range 36–54 years) who had undergone occipital nerve stimulator placement.

All patients had previously failed multiple conservative treatments such as therapy with nonsteroidal anti-inflammatory agents (NSAIDs), triptans, and/or tricyclic antidepressants; physical therapy; and chiropractic treatments.

 In addition, prior to occipital nerve stimulator placement each person had exhibited an improvement in headache pain severity of at least 50% after receiving occipital nerve blocks using a combination of dexamethasone (Decadron, Dexamethasone Intensol, Dexpak TaperPak) (4 mg) and 2% lidocaine (Xylocaine) (4 cc).

Headache frequency was recorded over a 30-day period and headache severity was measured on a pain scale of zero to 10 points. The highest severity and frequency were recorded for each of three visits preceding implantation of the occipital nerve stimulator; the average of the three measurements served as the baseline measurement of headache frequency and severity. Headache frequency and severity were also recorded 1, 3 and 6 months postimplantation.

Statistical analysis revealed a significant decrease in headache severity, from 9.0 ± 2.5 points on the pain scale preimplantation to 3.3 ± 1.6 points 6 months postimplantation.

Headache frequency also fell significantly. These significant improvements in headache severity and frequency were seen in the first month after implantation.

In the one complication reported, stimulator leads migrated away from the occipital nerves between 3 months and 6 months postimplantation.

These findings support further advances in the use of occipital nerve stimulation for medically intractable headaches, according to the researchers.


  1. Gaisford J, Straub T, LaBarbera D. Poster #447. “The role of occipital nerve stimulation for the treatment of chronic headaches at a pain management practice in Allen County, IN.” Presented at:  AAPA 2014 meeting. Boston; May 23-28, 2014.