Role of Occipital Nerve Stimulation for Sustained Pain Relief in Refractory Chronic Migraine

Abstract

Chronic migraine is a disabling neurological condition with a subset of patients remaining refractory to pharmacological therapy. Occipital nerve stimulation (ONS) has emerged as a neuromodulatory option in such cases. This case report describes a 38-year-old woman with a 2.5-year history of severe, refractory chronic migraine that had not responded adequately to multiple preventive and abortive medications or botulinum toxin A. She underwent bilateral ONS with implantation of a nonrechargeable implantable pulse generator and experienced immediate, sustained improvement, with pain falling from the Numeric Rating Scale of 10/10–0/10 and disability scores dropping markedly. Benefit was maintained for nearly 5 years with periodic reprogramming, and when symptoms recurred because of battery depletion, replacement with a rechargeable system restored significant pain relief. The report concludes that ONS can provide durable benefit in carefully selected patients with refractory chronic migraine, provided that long-term follow-up and hardware management are maintained.