Occipital nerve stimulation for headache: mechanisms and efficacy.

Headache disorders are common problems in medicine and it is this commonness that often provides an air of the simple or obvious. Patients expect doctors understand headache; indeed doctors expect they may understand headache, and in turn since simple treatments exist and can be purchased from a supermarket, the very concept of the difficult headache problem has a pejorative connotation. A decade ago none of the authors were using device-based therapies to any substantial extent, and now hardly a week goes by when we will not see a patient who has considerable potential to benefit from such approaches. Here we cover the most promising of the device-based approaches, neurostimulation therapy using occipital nerve stimulation. Far from proven and with much work to be done, this is an exciting potential development for patients and doctors. Other device-based therapies, such as deep brain stimulation for cluster headache and patent foramen ovale closure, are covered elsewhere.