Occipital Nerve Stimulation in the Pediatric Occipital Headache Population: A Case Series and Literature Review

Introduction: Occipital headaches are a disabling problem within the pediatric population. First-line treatment consists of conservative and pharmacological therapies followed by occipital nerve blocks and botulinum toxin injections for refractory cases. Unfortunately, many patients will have recurrence of their symptoms despite repeated treatments. In these refractory patients, surgical interventions can be employed. Occipital nerve stimulation (ONS) has been more recently utilized in the adult population as a minimally invasive treatment for headache disorders. Outcomes in afflicted adults following ONS have demonstrated a 72-89% reduction in pain compared to their pre-operative baseline; however, there are a paucity of studies regarding both its safety and efficacy in the pediatric population. In this combined single-institution clinical case series and literature review, we examined the indications for and outcomes of ONS in patients with medically-refractory occipital headaches.

Methods: We performed a literature review utilizing PubMed, Cochrane Reviews, SCOPUS, and Web of Science databases of studies that evaluated occipital nerve stimulation in pediatric patients for occipital headaches. Additionally, we performed a clinical chart review of pediatric patients at our institution who have undergone ONS for the same indication.

Results: Our literature review yield a total of 13 studies. After screening for duplicates and study relevance, only 2 manuscripts were included. Both studies showed an improvement in pain control following ONS implantation (either a reduction in pain attack frequency or intensity compared to baseline). We also identified 2 patients at our institution who underwent an ONS trial and/or permanent implantation for ON. One patient had complete relief of her symptoms after the trial and declined permanent implantation. The other patient had less frequent attacks compared to his pre-trial baseline and was able to control them by adjusting his stimulation settings.

Conclusion : Our study highlights the paucity of studies evaluating the utility of ONS in the pediatric occipital headache population. Limited data from both the literature and our institution’s experience reveal that pediatric patients may benefit from trial and/or permanent implantation of occipital nerve stimulators for occipital headaches.