Nerve stimulation for cluster headaches

Occipital nerve stimulation has been under investigation for the treatment of difficult to treat migraine headaches for the past several years with promising results.  A recent study at the Mayo Clinic in Scottsdale, AZ suggests that this treatment may also help relieve chronic cluster headaches.  It is less surprising that the occipital nerve stimulation works for cluster headaches than for migraines.  It is not unusual for cluster headache patients to complain of pain not only in the eye, but also in the back of the head on the same side.  Also, occipital nerve block with steroids has been shown to abort an episode of episodic cluster headaches and is widely used by headache specialists.  In chronic cluster patients this block may provide temporary relief and these patients may be good candidates for an occipital nerve stimulation.  The stimulator is usually implanted by a neurosurgeon in an out-patient procedure.  The wire electrode and the battery are embedded under the skin.  Another miniature stimulator which has been in development contains both the electrode and the battery in a very small capsule-size device.  This miniature stimulator is much easier to implant and it is less bothersome.          

  1. Alexandra says: 07/06/20127:33 pm

    I also live in Northern Ca and am going to see Dr. Goadsby in two weeks because I still have breakthrough pain that I can not control despite my ONS. I have had my ONS for two years now and it has changed my life, I was able to get off of most of my medications. However, I still have breakthrough pain that the stim does nt cover. I have had tremendous success at obtaining coverage through Blue Shield PPO. However, I have had six years of Botox injections and three years of occipital nerve blocks before they covered it. Dr. Jamie Henderon and his neurosurgery team are awesome at implants and obtaining coverage.

  2. Dr. Mauskop says: 01/02/20123:08 pm

    I would ask Dr. Goadsby about getting a vagus nerve stimulator (VNS) implanted instead. I know that Dr. Goadsby is familiar with my article in which I reported good results with VNS in 2 chronic cluster and 2 out of 4 chronic migraine patients. Even though VNS is less proven than ONS for migraine and cluster headaches, it has the advantage of having been approved by the FDA for refractory epilepsy and refractory depression, which makes it more likely to be covered by insurance companies. I decided to try this treatment because we routinely use epilepsy drugs and antidepressants for headaches, so if a treatment works for epilepsy and depression it had to have a decent chance of working for headaches, and it did. I will be happy to speak to Dr. Goadsby about how to approach the insurance company to get it to pay for VNS.
    Another treatment to consider before getting a stimulator implanted is Botox injections. They are also not approved by the FDA for cluster headaches, but the insurance might cover it since it is a lot less expensive than VNS or ONS. I have treated several patients with chronic cluster headaches with Botox with very good results.

  3. Richard Spindler says: 01/02/20123:22 am

    I have suffered from Refractory Chronic Cluster Headaches for over 3 years. None of the medications suppose to abort my headaches have worked. My Neurologist, Dr. Peter Goadsby, recommended ONS surgery, to be preformed by Dr. Edward Chang at UCSF Medical Center.
    My surgery was scheduled for 01/03/2012, until my Health Ins. Co. deemed the surgery “Exploratory and Investigative,” hence the surgery was denied and canceled.
    I would like to know, from anyone who had this surgery, what Health Insurance Co. they had that covered the procedure. This surgery is my last hope to regain some semblance of my life.
    I have Aetna Worldwide Ins. I have the ability to change to a Health Ins. Co. that has approved and covered this surgery in the past.
    I thank anyone in advance who can give me some of the information I am looking for.
    Richard Spindler

  4. Dr. Mauskop says: 03/25/20104:29 pm

    The miniature stimulator for headaches is made by Advanced Bionics Corp., CA, USA, but it does not seem to be available yet. Most likely it is still in clinical trials.

  5. marc says: 03/25/20103:55 pm

    Hello Dr Mauskop,

    I was wondering if you could tell me the company who is manufacturing the miniature stimulator/battery system that you mention above?

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