Refractory Chronic Migraine: Therapy with Combined Peripheral Neurostimulation

  • Roberto Arcioni
  • Paolo MartellettiEmail author
Part of the Headache book series (HEAD)


About 3 % of patients with episodic migraine each year trend toward a process of chronicity. These patients become refractory to prophylactic pharmacological therapy, leading to a high level of disability that affects their activities of daily living.


Chronic Migraine Episodic Migraine Great Occipital Nerve Implantable Pulse Generator Sphenopalatine Ganglion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Amin S, Buvanendran A, Park KS, Kroin JS, Moric M (2008) Peripheral nerve stimulator for the treatment of supraorbital neuralgia: a retrospective case series. Cephalalgia 28(4):355–359PubMedCrossRefGoogle Scholar
  2. 2.
    Asensio-Samper JM, Villanueva VL, Pérez AV, López MD, Monsalve V, Moliner S, De Andrés J (2008) Peripheral neurostimulation in supraorbital neuralgia refractory to conventional therapy. Pain Pract 8(2):120–124PubMedCrossRefGoogle Scholar
  3. 3.
    Bartsch T, Goadsby PJ (2003) Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain 126:1801–1813PubMedCrossRefGoogle Scholar
  4. 4.
    Becser N, Bovim G, Sjaastad O (1998) Extracranial nerves in the posterior part of the head. Anatomic variations and their possible clinical significance. Spine 23(13):1435–1441PubMedCrossRefGoogle Scholar
  5. 5.
    Burns B, Watkins L, Goadsby PJ (2009) Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients. Neurology 72:341–345PubMedCrossRefGoogle Scholar
  6. 6.
    D’Amico D, Leone M, Grazzi L, Bussone G (2008) When should “chronic migraine” patients be considered “refractory” to pharmacological prophylaxis? Neurol Sci 29(Suppl 1):S55–S58PubMedCrossRefGoogle Scholar
  7. 7.
    Datta S, Reed KL, Will KR (2011) Combined supraorbital and occipital nerve stimulation in failed surgical treatment of migraine: case report and review of the literature [abstract]. Presented at American Society of Intervention Pain Physicians 2012 Annual Meeting, Washington DC, Pain Physician, 2011Google Scholar
  8. 8.
    De Filippis S, Erbuto D, Gentili F, Innamorati M, Lester D, Tatarelli R, Martelletti P, Pompili M (2008) Mental turmoil, suicide risk, illness perception, and temperament, and their impact on quality of life in chronic daily headache. J Headache Pain 9(6):349–357PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Deshpande KK, Wininger KL (2011) Feasibility of combined epicranial temporal and occipital neurostimulation: treatment of a challenging case of headache. Pain Physician 14:37–44, This is the first report on combined cephalic neurostimulation since our original article (45 above)PubMedGoogle Scholar
  10. 10.
    Dodick DWST, Trentman TL, Zimmerman RS, Hentz J (2007) Trigeminal autonomic cephalalgias: current and future treatment. Headache 47:981–986CrossRefGoogle Scholar
  11. 11.
    Goadsby PJ, Knight YE, Hoskin KL (1997) Stimulation of the greater occipital nerve increases metabolic activity in the trigeminal nucleus caudalis and cervical dorsal horn of the cat. Pain 73:23–28PubMedCrossRefGoogle Scholar
  12. 12.
    Goadsby PJ, Zagami AS (1991) Stimulation of the superior sagittal sinus increases metabolic activity and blood flow in certain regions of the brainstem and upper cervical spinal cord of the cat. Brain 114:1001–1011PubMedCrossRefGoogle Scholar
  13. 13.
    Goadsby PJ, Hargreaves R (2008) Refractory migraine and chronic migraine: pathophysiological mechanisms. Headache 48(9):1399–1405PubMedCrossRefGoogle Scholar
  14. 14.
    Hoskin KL, Zagami AS, Goadsby PJ (1999) Stimulation of the middle meningeal artery leads to Fos expression in the trigeminocervical nucleus: a comparative study of monkey and cat. J Anat 194:579–588PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Linder S (2011) Combined occipital/supraorbital nerve stimulation for treatment of refractory headaches: initial adolescent experience (ages 12–17) [abstract]. Headache 51:47Google Scholar
  16. 16.
    Lionetto L, Negro A, Palmisani S, Gentile G, Del Fiore MR, Mercieri M, Simmaco M, Smith T, Al-Kaisy A, Arcioni R, Martelletti P (2012) Emerging treatment for chronic migraine and refractory chronic migraine. Expert Opin Emerg Drugs 17(3):393–406PubMedCrossRefGoogle Scholar
  17. 17.
    Magis D, Allena M, Bolla M (2007) Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 6:314–321PubMedCrossRefGoogle Scholar
  18. 18.
    Mammis A, Gudesblatt M, Mogilner AY (2011) Peripheral neurostimulation for the treatment of refractory cluster headache, long-term follow-up: case report. Neuromodulation 14:432–435PubMedCrossRefGoogle Scholar
  19. 19.
    Martelletti P, Jensen RH, Antal A, Arcioni R, Brighina F, de Tommaso M, Franzini A, Fontaine D, Heiland M, Jürgens TP, Leone M, Magis D, Paemeleire K, Palmisani S, Paulus W, May A (2013) Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain 14(1):86PubMedCrossRefGoogle Scholar
  20. 20.
    Narouze SN, Kapural L (2007) Supraorbital nerve electric stimulation for the treatment of intractable chronic cluster headache: a case report. Headache 47:1100–1102PubMedCrossRefGoogle Scholar
  21. 21.
    Palmisani S, Al-Kaisy A, Arcioni R, Smith T, Negro A, Lambru G, Bandikatla V, Carson E, Martelletti P (2013) A six year retrospective review of occipital nerve stimulation practice–controversies and challenges of an emerging technique for treating refractory headache syndromes. J Headache Pain 14(1):67PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Pompili M, Di Cosimo D, Innamorati M, Lester D, Tatarelli R, Martelletti P (2009) Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk. J Headache Pain 10(4):283–290PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Popeney C, Alo K (2003) Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine. Headache 43:369–375PubMedCrossRefGoogle Scholar
  24. 24.
    Reed KL, Black SB, Banta CJ, Will KR (2010) Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: initial experience. Cephalalgia 30:260–271PubMedGoogle Scholar
  25. 25.
    Reed KL, Will KR, Chapman J, Richter E (2011) Combined occipital and supraorbital neurostimulation for chronic migraine headaches: an extended case series [abstract]. Presented at 15th Congress of the International Headache Society, Berlin. Cephalalgia. pp 98–99Google Scholar
  26. 26.
    Schwedt TJ, Dodick DW, Trentman TL (2006) Occipital nerve stimulation for chronic cluster headache and hemicrania continua: pain relief and persistence of autonomic features. Cephalalgia 26:1025–1027PubMedCrossRefGoogle Scholar
  27. 27.
    Schulman E, McGeeney BE (2013) Current concepts in refractory migraine. Curr Treat Options Neurol 15(1):40–55PubMedCrossRefGoogle Scholar
  28. 28.
    Serafini G, Pompili M, Innamorati M, Gentile G, Borro M, Lamis DA, Lala N, Negro A, Simmaco M, Girardi P, Martelletti P (2012) Gene variants with suicidal risk in a sample of subjects with chronic migraine and affective temperamental dysregulation. Eur Rev Med Pharmacol Sci 16(10):1389–1398PubMedGoogle Scholar
  29. 29.
    Slavin KV, Colpan E, Munawar N, Wess C, Nersesyan H (2006) Trigeminal and occipital nerve stimulation for cranio-facial pain: a single-institution experience and review of the literature. Neurosurg Focus 21:1–5Google Scholar
  30. 30.
    Spencer SE, Sawyer WB, Wada H, Platt KB, Loewy AD (1990) CNS projections to the pterygopalatine para-sympathetic preganglionic neurons in the rat: a retrograde transneuronal viral cell body labeling study. Brain Res 534:149–169PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Pain Therapy Unit, Department of Medical, Surgical Science and Translational MedicineSapienza University of Rome, Sant’Andrea HospitalRomeItaly
  2. 2.Department of Clinical and Molecular Medicine, Regional Referral Headache CentreSapienza University of Rome, Sant’Andrea HospitalRomeItaly

Personalised recommendations