OCCIPITAL NEURALGIA AND HEADACHE - Health Plan of Nevada

stimulation persisted in more than half of the patients for whom the procedure was considered and in
80% of those who significantly improved during the trial and proceeded with internalization.
Weiner and Reed (1999) conducted a case series involving 13 patients (17 implant procedures) with
intractable occipital neuralgia treated with peripheral neurostimulation. Follow-up ranged from 1.5-6
years. Twelve patients reported good and excellence response with greater than 50% pain control and
little or no additional medication. The 13th patient was subsequently explanted following symptom
resolution.
Amin et al. (2008) evaluated the efficacy of supraorbital nerve stimulation for treatment of intractable
supraorbital neuralgia in a case series of 16 patients. The patients underwent a trial of supraorbital
nerve stimulation, and efficacy was assessed after 5-7 days. Ten patients consented to undergo
permanent implantation of the stimulator. Opioid consumption and headache scores were monitored
preoperatively and at timed intervals for 30 weeks. Headache scores decreased, and opioid
consumption was reduced in half, and these beneficial accomplishments were maintained up to 30
weeks after implantation.
The 2007 Hayes Technology Brief on electrical stimulation of the occipital nerve for the treatment of
occipital neuralgia summarized the available evidence stating that the results of the available studies
provide preliminary evidence that subcutaneous electrical stimulation of the greater and lesser occipital
nerves offers long-term relief in some patients who have intractable occipital neuralgia. Although the
available studies of this technique are small and uncontrolled, most of the patients in these studies had
experienced symptoms of occipital neuralgia for more than two years and had failed to respond
adequately to other conservative and aggressive treatments. Since occipital neuralgia is a rare disorder,
it does not seem feasible to conduct large-scale, randomized controlled trials to evaluate the efficacy of
electrical stimulation therapy versus other standard therapies; however, larger studies with longer
periods of follow-up are needed to confirm the benefits reported in the available studies. (Hayes, 2007)
The quality of evidence provided by studies for treatment of occipital neuralgia and cervicogenic
headache is generally low. Injection therapies, nerve blockades using steroids and anesthetic agents,
and surgical procedures such as nerve root decompression or neurectomy may provide effective pain
relief for some patients. However, the available studies were limited and had significant
methodological flaws, making it difficult to draw conclusions regarding the efficacy of the various
treatments. In addition, most treatments do not provide permanent curative results and recurrences
occurred in a high proportion of patients.
Additional Search Terms
cranial nerves, methylprednisolone, trigger points
U.S. FOOD AND DRUG ADMINISTRATION
Local Injection Therapy: Various local anesthetics are approved by the FDA for use in diagnostic and
therapeutic nerve blockade. Botulinum toxin-A (BTX-A or BOTOX) is a neurolytic agent that has also
been approved by the FDA for treatment of some conditions. However, BTX-A is not specifically
approved for treatment of cervicogenic headache or occipital neuralgia; the use of BTX-A for these
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