Occipital Nerve Stimulation in Chronic Migraine: The Relationship Between Perceived Sensory Quality, Perceived Sensory Location, and Clinical Efficacy—A Prospective, Observational, Non-Interventional Study

DOI: https://doi.org/10.1007/s40122-020-00194-0

Abstract-Summary The aim of this study was to analyze a potential relationship between sociodemo- graphic variables, headache parameters, perceived sensory quality, perceived sen- sory location, as well as clinical efficacy.

We used a computer-based imaging method for mapping the ONS-induced per- ceived sensory location, the perceived spatial sensory field size, as well as the

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perceived sensory quality in a long-term course over 21 months in weekly time intervals.

The effect of ONS on the migraine headache was documented weekly by the

participants using a verbal rating scale.

Over the observation period, a total of 808 individual weekly data sets were recorded and a potential relationship between ONS-induced perceptions and head- ache parameters could be analyzed.

The reported effectiveness did not differ depending on age, the average number of migraine days per month, the MIDAS score, or the duration of the migraine dis- order prior to ONS treatment.

The most frequently perceived sensory quality of “tingling” was found signifi-

cantly more frequently in non-responders than in responders.

Responders displayed significantly lower pleasantness scores for their reported

perceptions than non-responders.

Sensations that were spatially perceived above the line connecting the external acoustic meati with the external occipital protuberance (MOP line) led to patients reporting a positive clinical effect significantly more frequently than sensations spa- tially perceived below the MOP line.

Spatially small fields of sensory perception were correlated with a higher

responder rate than those covering broader areas.

The ONS-induced sensory location, the size of the spatial sensory field, as well as the sensory quality are significantly correlated with the reported clinical effectiveness.

Extended: The aim of this study was to evaluate a potential relationship between

supra-threshold-induced sensory perceptions and clinical effectiveness of ONS.

The most frequently reported sensation was that of “tingling”. Sensations that were perceived in location above the line connecting the external acoustic meati and the external occipital protuberance (MOP line) significantly more frequently led to patients reporting a positive clinical effect.

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m9.figshare.12859901.

Introduction Occipital nerve stimulation induces sensory experiences (i.e., prickling, tingling, pinching) in the area, where the leads are surgically placed.

The relationship between lead placement, the electrical stimulation parameters, the perceived location of the ONS-induced supra-threshold sensations, the per- ceived spatial sensory field size, and the perceived sensory qualities with the reported clinical effectiveness are also largely unknown.

For the analysis of this relationship, we used a computer-based imaging method [491] for mapping the ONS-induced perceived sensory location, the perceived

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spatial sensory field size, as well as the perceived sensory quality in a long-term course over 21 months in weekly time intervals.

The aim of this study was to evaluate a potential relationship between supra-

threshold-induced sensory perceptions and clinical effectiveness of ONS.

Methods Thirty-two subjects treated with ONS (25 female and seven male, mean age 45.77 ± 11.26 years, age range, 22–67  years) were recruited prospectively at the Kiel Migraine and Headache Center.

Patients had a mean history of chronic migraine for 30.35 ± 8.05 years (range, 10–46 years) and a mean history of 21 headache days/month (including both ten- sion type headache and migraine days) before ONS implantation (range, 15–30 days/month).

During the whole observation period of 21 months, 808 individual weekly data sets of the relationship between the perceived stimulus location, electrical stimula- tion parameters, induced sensory qualities, and the individual clinical effect were recorded.

One center performed a trial period of 3 days after implantation to evaluate elec-

trode positioning during this period.

The other center implanted electrodes and IPG in one setting without a

trial period.

The IPG was implanted at the same anatomical location in both centers.

Results Perceived sensory qualities that patients reported to be slightly uncomfortable like humming, vibrating, pulsating, pinching, or knocking were more frequent in responders than in non-responders.

Other than sensory quality, patients were also asked for sensory pleasantness

(visual rating scale 1 = “very pleasant” to 5 “very unpleasant”).

Responders showed significantly higher pleasantness-scores than non-respond- ers (pleasantness score of responders 3.01 ± 0.81; non-responders 2.23 ± 1.01; p < 0.0001).

Discussion We examined, to our knowledge, for the first time a possible relationship in supra- threshold sensory perception between perceived sensory quality, perceived sensory location, perceived spatial field size, and individual clinical effect in the treatment of chronic migraine with occipital nerve stimulation in the long term.

It remains unclear whether occipital nerve stimulation is also clinically effective

in sub-threshold sensory perception.

We recommend to individually select electrical parameters during programming that induce such sensations to more likely achieve a higher clinical effectiveness using ONS.

Sensations that were perceived in location above the line connecting the external acoustic meati and the external occipital protuberance (MOP line) significantly more frequently led to patients reporting a positive clinical effect.

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The individual active electrode poles should be programmed in such a way that a sensory perception in a spatially small perceptive field close to the midline and above the occipital protuberance over the main branches of the occipital nerve results.

Conclusions The ONS-induced sensory location, the size of the spatial sensory field, as well as the sensory quality are significantly correlated with the reported clinical effectiveness.

The results suggest that besides surgical technique, the individual and continu- ous programming of the stimulation parameters is important in increasing the thera- peutic effectiveness.

Acknowledgement A machine generated summary based on the work of Göbel, Carl H.; Göbel, Anna; Niederberger, Uwe; Heinze, Axel; Heinze-Kuhn, Katja; Meinecke, Christoph; Mehdorn, Hubertus M.; Rasche, Dirk; Göbel, Hartmut. 2020 in Pain and Therapy.

Peripheral nerve stimulation registry for intractable migraine headache (RELIEF): a real-life perspective on the utility of occipital nerve stimulation for chronic migraine