Introduction: Defined as a headache lasting at least 15 days per month, chronic headache is reported by 3% of the general population, and a substantial proportion of them are refractory to current therapies. Occipital nerve stimulation (ONS) is a treatment option, but is still considered as a last resort treatment especially because of its invasive nature and the cost associated. The aim of this review is to assess the efficacy and safety of ONS in regards to non-migrainous chronic headache.
Methods: We have conducted a systematic review with meta-analysis of patients with chronic headache excluding migraine treated by ONS. MEDLINE, Embase, and the Cochrane Library databases were searched for eligible studies. ONS was compared to sham stimulation or the best available treatment including injections, ablative techniques, and pharmacological or psychological interventions. Two independent reviewers processed to the screening of studies according to titles, abstracts, and then full texts. Using a standardized form, reviewers extracted the data from selected studies.
Results: The primary outcome is overall reduction of head pain severity. The secondary outcomes includes rates of reduction in severity of head pain, headache frequency, and duration, use of medication, quality of life, and adverse events. The risk of bias and the heterogeneity of the studies were also independently assessed based on the Cochrane Collaboration tool.
Conclusions: This systematic review will allow us to better assess the potential role of ONS for the treatment of patients with chronic headache excluding migraines that are refractory to less invasive therapies.
Patient Care: This review will help to design and conduct future randomized controlled trials focused on patients who may better respond to such treatment.
Learning Objectives: This review will also bring a clear evidence of ONS efficacy for the treatment of non-migraine headache disorders. From a clinical standpoint, this review will clarify the relevance of offering this expensive and invasive treatment.