Hybrid High Cervical and Occipital Nerve Stimulation for Chronic Intractable Migraine (P4.140)

Objective: In this case series, we examined the feasibility of neuromodulation with leads placed both epidurally in the high cervical spine and peripherally over the occipital nerve(s) in approximately 20 patients diagnosed with chronic intractable migraine headaches, with or without aura, at a single-site. Background: Chronic migraine is a costly and debilitating disorder affecting an estimated 1.4–2.2%of the global population (Natoli, J. et al. Cephalalgia 2010 ) . Occipital nerve stimulation (ONS) has been proposed as an effective treatment for reducing chronic migraine pain inpatients that are not responsive to medical treatment or over use medication. However, efficacy results from prospective studies of ONS have been mixed (Saper, J. et al. Cephalalgia 2011; Serra and Marchioretto, Pain Physician 2012; Schwedt, T. Cephalalgia 2007) High cervical spinal cord stimulation (SCS)has shown promising results for both cluster and chronic migraine headaches (De Agostino, R. et al. Neuromodulation 2015; Wolter, T. et al. Cephalalgia 2008; Wolter, T. et al. Cephalalgia 2011) . Advances in recent SCS technology include a 32-contact system that allows for placement of four8-contact leads to deliver hybrid neurostimulation simultaneously at both the occipital nerves and the high cervical spinal cord. Design/Methods: Patients diagnosed with chronic intractable migraine who underwent SCS trial and subsequent implant for using a multiple waveform SCS system (Precision Spectra, Boston Scientific) with leads placed both epidurally in the high cervical spine and peripherally over the occipital nerve(s) were enrolled. Results: Results will be presented in this on-going study including baseline demographics and change in NRS from baseline to last follow-up for approximately 20 patients. Conclusions: This study supports the postulate that a hybrid system utilizing four leads for both ONS and SCS delivers promising improvements in pain outcomes. Further study of hybrid ONS and SCS for the treatment of chronic intractable migraine is warranted. Study Supported by: Boston Scientific Disclosure: Dr. Domangue has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Boston Scientific. Dr. Chen has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Boston Scientific. Dr. Lechleiter has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Boston Scientific. Dr. Jain has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Boston Scientific. Dr. Jain has received research support from Boston Scientific.