title: Occipital nerve stimulation for chronic migraine: a randomized trial on subthreshold stimulation.
abstract: BACKGROUND
  Occipital nerve stimulation (ONS) may provide pain relief in migraine patients. In this double-blinded trial we investigated the significance of paresthesia and possible placebo effects.
  
  
  METHODS
  Patients already treated with ONS reporting stable treatment effect were included. "Effective stimulation," "subthreshold stimulation" and "no stimulation" were compared. Patients cycled through all three treatment groups. Outcome was measured using the visual analog scale (VAS) for pain, McGill Pain Questionnaire and SF-36.
  
  
  RESULTS
  Eight patients were included, mean preoperative VAS was 8.20 ± 1.22. A significant improvement in pain was observed in favor of suprathreshold stimulation compared to subthreshold stimulation (1.98 ± 1.56 vs 5.65 ± 2.11). Pain also significantly improved under subthreshold stimulation compared to no stimulation (5.65 ± 2.11 vs 8.45 ± 0.99). No changes in SF-36 were observed.
  
  
  CONCLUSIONS
  Paresthesia is not required to achieve pain reduction but suprathreshold stimulation yields better results, underlining the significance of stimulation parameter customization.
authors.affiliation: Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Düsseldorf, Germany slotty@hhu.de.
authors.forename: P J
authors.initials: PJ
authors.lastname: Slotty
authors.affiliation: Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Düsseldorf, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Bara
authors.affiliation: Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Düsseldorf, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Kowatz
authors.affiliation: Headache and Pain Center, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gendolla
authors.affiliation: Neurochirurgische Praxis-Klinik, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Wille
authors.affiliation: Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Düsseldorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schu
authors.affiliation: Department of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich-Heine University Düsseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Vesper
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000628:therapy*; D010147:Pain Measurement; D010525:Peripheral Nerves
keywords: Occipital nerve stimulation; migraine; paresthesia; primary headache disorders; randomized trial