1. 2014;17;E369-E374The Effects of Peripheral Occipital Nerve Stimulation for the Treatment of Patients Suffering from Chronic Migraine: A Single Center Experience
   Case Report
   Paolo Notaro, MD, Elisa Buratti, MD, Adriano Meroni, MD, Maria Cesarina Montagna, MD, Fabio Gerardo Rubino, MD, and Alessandra Voltolini, MD.

About 1% of patients suffering from chronic migraine do not respond to medications and require more invasive treatments. Occipital nerve stimulation (ONS) is one of these new therapeutic options. The aim of this data review is to evaluate the clinical impact of ONS and whether the neuropsychological aspects of anxiety and depression can be considered as predictors of therapeutic effects.

Seventeen migraine patients, according to the ICHD-II classification, were treated with ONS. At baseline all patients were assessed by numeric rating scale (NRS), Migraine Disability Assessment (MIDAS), SF-36 Health Survey (SF-36), Beck Depression Inventory II (BDI II), and Beck Anxiety Inventory (BAI) questionnaires. MIDAS and NRS were re-assessed at 3 and 12 month follow-up visits, while SF-36 was evaluated after 12 months of stimulation. The population was divided in 2 subgroups based on MIDAS improvement, and BDI II and BAI scores in the 2 subpopulations were compared to investigate whether anxiety and depression can be considered as predictive factors of clinical outcomes. MIDAS showed a significant reduction both at 3 and 12 month visits and NRS scale showed the same trend. The SF-36 questionnaire showed a significant improvement not only in Physical Component Summary (PCS) and Mental Component Summary (MCS) indices, but also in sub-dimensions. Patients who reported a MIDAS improvement = 40% showed a significant difference in BDI-II test at baseline.

Significant clinical improvements were obtained already after 3 months of treatment and stayed stable throughout the first year after the procedure. ONS seems to be an effective and safe treatment for chronic migraine. The effects of ONS can be optimized by a multidisciplinary diagnostic and therapeutic approach, especially for the importance of the psychological factors in pain perception and their correlation with a good therapeutic outcome. Our experience highlighted that a multidisciplinary team which includes psychological support and psychosocial rehabilitation is essential for the success of this therapy.