Despite the advances in the management of headache disorders, many patients suffering from chronic migraine are refractory to current treatments. New treatments backed by good evidence are therefore in great need. Electrical stimulation of peripheral nerves is used to treat various painful conditions including headache disorders. More recently it has been reported good outcome in these painful conditions with subcutaneous placement of leads at the level of C1 and stimulation of the greater occipital nerve: This procedure is named Occipital Nerve Stimulation (ONS). The clinical conditions treated with ONS include occipital neuralgia, Trigeminal Autonomic Cephalalgias (TACs), migraine and transformed migraine.
The surgical procedure is divided in two steps. In the first step, with the patient in prone position under local anaesthesia, a vertical incision of 2 cm is made in posterior cervical region in the midline on the external occipital protuberance. Under fluoroscopy control, a Tuohy needle is passed transversely in the subcutaneous space across the base of the greater occipital nerve at the level of C1 starting from the midline incision towards the mastoid process and following the trajectory of the nuchal line.