Occipital nerve stimulation & DBS
Occipital nerve stimulation (ONS) places electrodes under the skin near nerves at the back of the head. It may be considered for selected patients with refractory chronic cluster headache or chronic migraine after specialist assessment. DBS may be considered in particularly selected refractory cases. These treatments require specialist selection, programming and long-term follow-up; they are not routine treatments for everyday headache.
Facial pain and related disorders
SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) and SUNA (short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms) may be assessed jointly by headache specialists and neurosurgeons. The diagnosis and imaging determine whether a nerve-directed procedure could help.
Understanding uncertainty
Improvement varies and symptoms may persist. Implanted systems can cause infection, discomfort or hardware problems and may need revision. DBS also carries the risks of brain surgery. The team will explain the evidence, eligibility and any special treatment arrangements.