title: Occipital Nerve Stimulation for the Treatment of Patients With Medically Refractory Occipital Neuralgia: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline.
abstract: BACKGROUND
  Occipital neuralgia (ON) is a disorder characterized by sharp, electrical, paroxysmal pain, originating from the occiput and extending along the posterior scalp, in the distribution of the greater, lesser, and/or third occipital nerve. Occipital nerve stimulation (ONS) constitutes a promising therapy for medically refractory ON because it is reversible with minimal side effects and has shown continued efficacy with long-term follow-up.
  
  
  OBJECTIVE
  To conduct a systematic literature review and provide treatment recommendations for the use of ONS for the treatment of patients with medically refractory ON.
  
  
  METHODS
  A systematic literature search was conducted using the PubMed database and the Cochrane Library to locate articles published between 1966 and April 2014 using MeSH headings and keywords relevant to ONS as a means to treat ON. A second literature search was conducted using the PubMed database and the Cochrane Library to locate articles published between 1966 and June 2014 using MeSH headings and keywords relevant to interventions that predict response to ONS in ON. The strength of evidence of each article that underwent full text review and the resulting strength of recommendation were graded according to the guidelines development methodology of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Committee.
  
  
  RESULTS
  Nine studies met the criteria for inclusion in this guideline. All articles provided Class III Level evidence.
  
  
  CONCLUSIONS
  Based on the data derived from this systematic literature review, the following Level III recommendation can be made: the use of ONS is a treatment option for patients with medically refractory ON.
authors.affiliation: *Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio; ‡Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; §Department of Anesthesiology and Pain Management, Western Reserve Hospital, Cuyahoga Falls, Ohio; ¶Departments of Neurosurgery and Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania; ‖Department of Neurosurgery, St. Luke's University Health Network, Bethlehem, Pennsylvania; #Department of Neurosurgery, Henry Ford Medical Group, West Bloomfield, Michigan; **Department of Neurosciences, Cleveland Clinic, Lerner Research Institute, Center for Neurological Restoration, Cleveland, Ohio; ‡‡Department of Neurosurgery, Northwestern University Medical School, Chicago, Illinois; §§Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; ¶¶Department of Anesthesiology, University Hospitals Case Medical Center, Cleveland, Ohio; ‖‖Division of Neurosurgery, Beth Israel Deaconess, Boston, Massachusetts; ##Division of Neurosurgery, Albany Medical College, Albany, New York.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sweet
authors.forename: Laura S
authors.initials: LS
authors.lastname: Mitchell
authors.forename: Samer
authors.initials: S
authors.lastname: Narouze
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Falowski
authors.forename: Jason M
authors.initials: JM
authors.lastname: Schwalb
authors.forename: Andre
authors.initials: A
authors.lastname: Machado
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Rosenow
authors.forename: Erika A
authors.initials: EA
authors.lastname: Petersen
authors.forename: Salim M
authors.initials: SM
authors.lastname: Hayek
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Arle
authors.forename: Julie G
authors.initials: JG
authors.lastname: Pilitsis
mesh_terms: D004599:Electric Stimulation Therapy / Q000379:methods*; D019317:Evidence-Based Medicine; D006261:Headache / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009437:Neuralgia / Q000503:physiopathology / Q000628:therapy*; D013127:Spinal Nerves / Q000503:physiopathology*