Stimulation ranges, usage ranges, and paresthesia mapping during occipital nerve stimulation

Introduction. Subcutaneous, occipital nerve stimulation has emerged as a potentially effective treatment modality for patients with refractory headache disorders. The purpose of this study was to document occipital stimulation characteristics in 10 patients status post implantation of an occipital nerve stimulator. Methods. All possible electrode combinations were tested in each patient, and sensory threshold, discomfort threshold, and associated paresthesia maps were noted. Results. Mean perception threshold was 1.07 V and mean discomfort threshold was 3.63 V. The associated paresthesia maps demonstrated that most patients felt stimulation as expected in the occipital regions; trigeminal distribution stimulation occurred but only in a minority of patients. Half of the patients experienced ≥ 50% reduction in headache frequency or severity. Conclusions. These results should aid in clinical decision-making and manufacturing requirements for this modality; larger, prospective studies will be needed to determine the safety and efficacy of stimulation techniques for headache disorders.