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Orofacial Pain Syndromes and Other Facial Neuralgias
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
As ON is well localized, it is possible to consider various surgical treatments including ablation, decompression and electro-modulation of the C2 nerve (91). The C2 dorsal root ganglionectomy has also been used successfully (91). Patients who do not tolerate conservative treatments as well as occipital nerve blocks or other invasive procedures may, if the nerves have not been ablated, be candidates for occipital nerve stimulation. Electrical stimulation of the occipital nerve engenders both peripheral and central nervous system effects that modulate nociception (92). It has also been noted that response to occipital nerve block is not, in and of itself, a good predictor of success or failure of occipital nerve stimulation (93).
The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Occipital nerve stimulation activates pain modulation pathways in the spinal cord and brainstem. Mechanoreceptor stimulation of the occipital nerves (the greater, lesser, and least or third) reaches the C2 and C3 spinal cord segments and trigeminocervical complex. From here, information ascends to the rostral ventromedial medulla, dorsolateral pontomesencephalic tegmentum, periaqueductal gray, thalamus, and cortex. Endogenous analgesic pathways from brainstem to spinal cord modulate pain processing through inhibitory anti-nociceptive projections to the cervical dorsal horn.
Emerging drugs for migraine treatment: an update
Published in Expert Opinion on Emerging Drugs, 2018
Giorgio Lambru, Anna P. Andreou, Martina Guglielmetti, Paolo Martelletti
Despite the broad arsenal of treatments, there is still a vast unmet need for novel migraine treatments. This includes: Better tolerated abortive treatments, which could also be used in specific subgroup of migraine patients, namely, the pediatric population, pregnant women, subjects with comorbid cardiovascular and/or cerebrovascular diseases and the elderly migrainous population.More effective abortive treatments that may be beneficial in the triptan non-responder population.Preventive treatments with better tolerability profiles, long-term safety, and patient-friendly administration routes.Specifically-designed migraine preventive treatments, which tackle pivotal pathways involve in migraine pathophysiology.Preventive treatments for CM refractory to established medical treatments. At present no pharmacological treatments hold compelling evidence of efficacy in this challenging-to-treat group of people. Furthermore, invasive neurostimulation approaches, such as occipital nerve stimulation, have failed to demonstrate a meaningful therapeutic effect in clinical trials.
A device review of Relivion®: an external combined occipital and trigeminal neurostimulation (eCOT-NS) system for self-administered treatment of migraine and major depressive disorder
Published in Expert Review of Medical Devices, 2021
Oved Daniel, Roni Sharon, Stewart J. Tepper
Occipital nerve stimulation, which has evolved following successful attempts of high cervical spinal cord stimulation in treating pain, is an invasive PNS procedure that has been reported to provide relief for patients with chronic migraine in clinical trials. Nevertheless, subsequent pivotal, prospective studies evaluating ONS efficacy for chronic migraine treatment failed to produce the desired robust effect [5,24,30–35]. Although this procedure may still hold promise, noninvasive stimulation of the occipital nerve is challenging due to the nerve’s distance from the electrodes, the increased impedance due to the presence of hair and the potential of causing electrically induced contractions in neighboring cervical muscles, which may also lead to patient discomfort.
Peripheral nerve stimulation: black, white and shades of grey
Published in British Journal of Neurosurgery, 2019
Viraat Harsh, Parijat Mishra, Preeti K Gond, Anil Kumar
Occipital nerve stimulation was first developed in 1992. It is used in occipital neuralgia in which the pain is refractory to medical or surgical treatment. It is also indicated in cases of transformed migraine with occipital pain and discomfort, and in cervicogenic occipital pain. Inappropriate proximity of the electrode to the fascia may result in burning pain or motor response hints. Repeat attempts at more superficial positioning of the electrode is advised, however, multiple attempts at needle passage for electrode placement is discouraged as it may lead to subcutaneous edema and/or hematoma formation which might reduce the electrode conductivity.