occipital neuralgia and cervicogenic, cluster and migraine headaches

patient has had the pain, and the presumed etiology of the pain. The pain must have been present for at
least three months. Other appropriate treatment modalities must have been tried and failed, and the
medical record must document what treatment modalities have been used. The presumed etiology of
the pain must be a type that is accepted as responding to TENS therapy. Examples of conditions for
which a TENS unit are not considered to be reasonable and necessary are (not all-inclusive):
headache, visceral abdominal pain, pelvic pain, and temporomandibular joint (TMJ) pain.
When used for the treatment of chronic, intractable pain, the TENS unit must be used by the patient on
a trial basis for a minimum of one month (30 days), but not to exceed two months. The trial period will
be paid as a rental. The trial period must be monitored by the physician to determine the effectiveness
of the TENS unit in modulating the pain. For coverage of a purchase, the physician must determine
that the patient is likely to derive significant therapeutic benefit from continuous use of the unit over a
long period of time. The physician's records must document a reevaluation of the patient at the end of
the trial period, must indicate how often the patient used the TENS unit, the typical duration of use
each time, and the results.
The physician ordering the TENS unit must be the attending physician or a consulting physician for the
disease or condition resulting in the need for the TENS unit.
For Medicare and Medicaid Determinations Related to States Outside of Nevada:
Please review Local Coverage Determinations that apply to other states outside of Nevada.
http://www.cms.hhs.gov/mcd/search
Important Note: Please also review local carrier Web sites in addition to the Medicare Coverage
database on the Centers for Medicare and Medicaid Services’ Website.
BACKGROUND
Cervicogenic headache and occipital neuralgia are conditions whose diagnosis and treatment have been
gradually refined over the last several years. This terminology has come to refer to specific types of
unilateral headache thought to arise from impingement or entrapment of the occipital nerves and/or the
upper spinal vertebrae. Compression and injury of the occipital nerves within the muscles of the neck
and compression of the second and third cervical nerve roots are generally felt to be responsible for the
symptoms, including unilateral and occasionally bilateral head, neck, and arm pain. The criteria for
diagnosis of these entities currently include those of the International Headache Society (IHS) and the
Cervicogenic Headache International Study Group.
Various treatments have been advocated for cervicogenic headache and occipital neuralgia. Oral
analgesics and anti-inflammatory agents are effective for some patients, but there is a population of
patients who do not experience pain relief with these medications. Local injections, epidural steroid
injections, radiofrequency ablation of the planum nuchae, electrical stimulation, rhizotomy,
ganglionectomy, nerve root decompression, discectomy and spinal fusion have all been investigated in
the treatment of cervicogenic headache and occipital neuralgia.
Occipital Neuralgia & Headache Page 3 of 24