Freeman John A, Trentman Terrance L
Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA.
Med Devices (Auckl). 2013 Nov 20;6:195-201. doi: 10.2147/MDER.S27109.
Chronic migraine is a disabling disorder that is costly to individuals and society. Occipital nerve stimulation has been used to treat refractory cases of primary headache disorders including drug-resistant chronic cluster headaches and chronic migraine. The Food and Drug Administration (FDA) off-labeled application of equipment used for peripheral nerve (occipital) stimulation is borrowed from FDA-labeled spinal cord stimulation. Manufacturer-sponsored randomized trials include a feasibility study (ONSTIM-Medtronic) and a safety and efficacy study (St Jude). A non-industry sponsored prospective, randomized crossover study by Serra and Marchiotretto suggests improved quality of life and a significant reduction in medication use. Though preliminary studies suggest occipital nerve stimulation is safe and efficacious in treating chronic migraine headache, complication rates, including lead migration, lead fracture, and surgical site infections remain high. Further studies are needed to demonstrate long-term outcomes, while improved surgical techniques and site-specific equipment are needed to minimize complications.
慢性偏头痛是一种致残性疾病，对个人和社会都造成高昂代价。枕神经刺激已被用于治疗原发性头痛疾病的难治性病例，包括耐药性慢性丛集性头痛和慢性偏头痛。美国食品药品监督管理局（FDA）对用于外周神经（枕神经）刺激设备的非标签应用借鉴了FDA标签的脊髓刺激。制造商赞助的随机试验包括一项可行性研究（ONSTIM - 美敦力公司）和一项安全性与有效性研究（圣犹达医疗用品公司）。Serra和Marchiotretto进行的一项非行业赞助的前瞻性随机交叉研究表明，生活质量得到改善，药物使用显著减少。尽管初步研究表明枕神经刺激在治疗慢性偏头痛方面安全有效，但包括导线移位、导线断裂和手术部位感染在内的并发症发生率仍然很高。需要进一步研究以证明长期疗效，同时需要改进手术技术和特定部位的设备以尽量减少并发症。
