Focus of the Report: This report focuses on occipital nerve stimulation (ONS) for treatment of chronic cluster headache (CH) that has failed to respond to available drug treatments.

Technology Description: ONS involves electrical stimulation of the greater and/or lesser occipital nerves at the back of the head. It is performed with electrodes that are implanted subcutaneously over the nerves and connected to a battery-powered internal pulse generator that is subcutaneously implanted in a pocket in the chest, abdomen, or lower back. ONS is generally performed in an outpatient setting.

Controversy: ONS is an invasive technique that requires surgical implantation of a stimulator. Some patients obtain limited or no relief from this treatment, and it is difficult to predict which patients with chronic CH will benefit.

Key Questions:

  • Does ONS improve CH outcomes in patients whose symptoms have not responded to standard therapies?

  • How does ONS compare with alternative technologies (e.g., deep brain stimulation)?

  • Is ONS safe for treatment of CH?

  • Have definitive patient selection criteria been identified for ONS for the treatment of CH?

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