Occipital nerve stimulation

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Occipital nerve stimulation for medically refractory chronic cluster headache.

Outcome of the appraisal


Occipital nerve stimulation shows promise for treating medically refractory chronic cluster headache, but the evidence is insufficient to support routine adoption.


There is uncertainty about the therapeutic impact of occipital nerve stimulation from the non-comparative evidence available and the economic consequences are difficult to estimate. Further research is recommended to determine the impact of occipital nerve stimulation on the frequency and severity of cluster headache attacks, quality of life and cost implications.

Why was this topic appraised?


Chronic cluster headache is a rare form of headache disorder that gives rise to severe and sometimes intractable symptoms. The headache attacks are managed with a range of different drugs. A small proportion (between 5% and 20%) of people with chronic cluster headache are refractory to drug treatment and these people continue to experience daily or almost-daily headache attacks. The implantation of a device to stimulate the occipital nerves has been proposed as a means of modulating the frequency and severity of cluster headache attacks that do not respond well to drug treatment.


This topic was suggested through the Welsh Health Specialised Services Committee (WHSSC). Current access to occipital nerve stimulation for eligible Welsh patients is through individual patient funding requests and referral to NHS England.

Plain language summary


Health Technology Wales (HTW) looked at evidence that occipital nerve stimulation can be used to treat chronic cluster headaches that don’t respond to usual treatments.


Chronic cluster headaches are a rare form of headache that are very painful. They are usually treated through medicines that aim to prevent the headaches or treat the headache symptoms. However, a small number of people don’t respond to treatment.


Occipital nerve stimulation involves electrical stimulation of the occipital nerves, which are at the back of the head.  Leads containing electrodes are implanted under the skin over the occipital nerves. The leads are connected to a battery that is usually placed under the skin in the chest. The device sends mild electric pulses along these nerves, which aims to reduce the pain of the headache.


HTW’s Guidance does not currently support routine adoption of occipital nerve stimulation because there isn’t enough evidence to show the benefits of the procedure.  However, HTW supports the continued access of occipital nerve stimulation through the individual patient funding request (IPFR) process. HTW recommends that more research should be done.

Topic Exploration Report

TER062 09.2019

Evidence Appraisal Review

EAR013 12.2019


GUI013 12.2019

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