Migraines and Nerve Stimulationby Joseph Kim, MD, MPH | February 28, 2009
Nerve stimulation therapy is used to treat many different types of disorders, including back pain, epilepsy, depression, and headaches. Some recent clinical findings were presented at the 2009 American Academy of Pain Medicine (AAPM) annual meeting held in Honolulu, Hawaii. Wouldn’t you love to go to Hawaii for a medical meeting?
The research was on the use of occipital nerve stimulation for refractory migraines. Vagus nerve stimulation has been used very successfully to treat epilepsy. A stimulator gets implanted under the skin (similar to a pacemaker) and then electric impulses are sent up the vagus nerve in the neck. You won’t be getting through airport security smoothly if you have one of these devices implanted in you. Of course, the bulge under your skin should be a clue that you have a medical device implanted in your body.
So what about occipital nerve stimulation?
According to the presentation by Joel Saper, M.D., of the Michigan Head Pain and Neurological Institute in Ann Arbor, occipital nerve stimulation may be a promising option for patients with intractable chronic migraine headaches. According to his study, 39% of patients had relief when they received nerve stimulation while 0% of patients had relief when they took standard medications. This device is currently still investigational, so don’t expect to get in line right away if you have chronic intractable migraines. The FDA has to approve it before it becomes publicly available. Adverse reactions reported in this study included lead migration (where the implanted lead moved around) and worsened headaches. This device was tested in 68 patients, so that’s a small study. You may be wondering how the leads moved around. Well, try to imagine a long wire going up from your stomach area, up your back, and to the bottom of your head. That’s essentially the way this device is implanted. The stimulator device goes somewhere in your belly and the long electrical leads are carefully placed up your back and they end up next to the occipital nerve which is near the bottom of your skull. Doesn’t sound too fun, does it? Then again, the implantation of medical devices is not something you’d want to have done to you unless you really needed it.
Would you be willing to have a battery-powered implanted device to treat your migraines? Or do triptans and other medications work for your headaches?
Commonly used migraine drugs include triptans such as Sumatriptan (Imitrex), Zolmitriptan (Zomig), Naratriptan (Amerge), Rizatriptan (Maxalt), Almotriptan (Axert), and Frovatriptan (Frova). They come as tablets, nasal sprays, and injections. Most people find that they work really well, but they can have some serious drug-drug interactions and they shouldn’t be used in patients with certain risk factors.
As technology allows device makers to develop implantable nerve stimulators and other devices, the management of difficult conditions like migraines may improve. It may be difficult to really understand how that may impact your life unless you’re the one with chronic intractable migraines and nothing ever works for you. Migraines can be extremely debilitating and if you’re the one who’s suffering all the time, then you may be willing to have a battery-powered electrical device implanted in your belly with wires going up your back and ending near the bottom of your skull. If you don’t think you can tolerate that, then let’s hope that better medications and non-invasive strategies will improve.
Saper J, et al. Occipital nerve stimulation (ONS) for treatment of intractable migraine headache: 3-month results from the ONSTIM feasibility study. American Academy of Pain Medicine. 2009; Abstract 155.
B. Burns, L. Watkins, P. J. Goadsby (2009). Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients Neurology, 72 (4), 341-345 DOI: 10.1212/01.wnl.0000341279.17344.c9
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