A key treatment for headache and craniofacial pain is occipital nerve stimulation (ONS). Originating in the late 1970s, this method involves implanting a device that integrates an electrode and pulse generator, designed to stimulate the occipital nerve situated at the base of the neck.

The implantable device’s lead, or electrode, is placed in subcutaneous tissues near the greater and lesser occipital nerves, while the generator is implanted in a subcutaneous pocket either in the back, abdomen, or chest. Before permanent implantation, the safety and effectiveness of the procedure are tested in the patient using leads positioned under the skin, connecting to an external battery.

Following an initial inpatient trial (under sedation) the patient continues with the therapy for up to a week, maintaining a pain diary. Physicians consider permanent implantation in cases where the patient records both significantly less pain and a substantially improved quality of life.

Clinical studies back the long-term beneficial effects of ONS. In a study of patients experiencing chronic migraines, findings revealed that 40 percent reported lasting benefits for up to four years after ONS therapy. Another study involving individuals with chronic cluster headaches showed positive effects persisting for up to six years post-treatment.