A Systematic Review of Clinical Outcomes Utilizing Combined Occipital Nerve (ONS) and Supraorbital Nerve (SON) Stimulation in the Treatment of Chronic Migraine
Jeffery Kramer1, Brian Grosberg2, Samer Narouze3
1Volta Research and Consulting, 2Hartford HealthCare Headache Center, 3Western Reserve Hospital
Objective:
Perform a systematic literature review of combined occipital and supraorbital (V1) stimulation in the treatment of chronic migraine.
Background:
Neuromodulation of somatic nerves in the head has been shown to be effective in the treatment of multiple headache types including chronic migraine. It has been suggested that combined occipital and supraorbital nerve stimulation may provide benefit in chronic migraine.
Design/Methods:
A systematic literature review was performed to examine the clinical outcomes of combined occipital and supraorbital trigeminal (V1) stimulation for chronic migraine. Appropriate specified search terms, developed a priori, were utilized in conjunction with Pubmed, EMBASE, and Google Scholar. Back searches through cited references were also utilized. Due to the relatively small anticipated literature base, all published items that utilized combination were included in the review.
Results:
Fourteen (14) publications including a total of n=331 patients were obtained through the systematic review. Clinical outcomes demonstrated a wide range of responder rates (42-100%) due to a number of factors including system technology (implantable versus non-implantable), headache severity, and outcomes timelines. A subset of 12 published items focused on implantable neuromodulation therapies (n=254 patients). For patients with chronic migraine, the weighted average responder rate (>50% reduction) was 82.8% for headache severity (range 50-100%, n=222 patients) with a weighted 73.7% average reduction in headache days (range 73-92%, n=185 patients). Adverse events most commonly included lead migration and fracture (9-45%) as well as infection (5-27%).
Conclusions:
Prior published research has shown promising outcomes in terms of reducing both headache severity and headache days in patients implanted with neurostimulators combining ONS and SON. While the potential therapeutic utility has shown promise, additional research is needed to better identify patient responders, optimize stimulation paradigms, and improve technologies to overcome device-related limitations.