Occipital Nerve Stimulation for Chronic Refractory Migraine

Chronic migraine remains disabling for a significant proportion of the population and challenging for medical providers. In addition to pharmacological treatment, peripheral nerve stimulation has been shown to provide satisfactory pain relief and improved quality of life. In this chapter, an illustrative case of occipital nerve stimulation (ONS) for refractory chronic migraine is presented, including the preoperative assessment and planning, decision making process, detailed surgical technique, aftercare and follow-up. A complication and its management are also described and discussed in detail and supplemented with clinical pearls. This discussion is accompanied by a review of the relevant evidence and outcomes from the literature.