Migraines are a serious health issue today. According to the Migraine Research Foundation, nearly one in four U.S. households includes someone with migraine, which equates to approximately 12 percent of the population.
There are a variety of different treatments and ways to try and manage migraines today; and each offers varying levels of success. One treatment that is gaining wide acceptance in recent years is supraorbital nerve stimulation.
What is Supraorbital Nerve Stimulation?
In supraorbital transcutaneous stimulation, a stimulator device is placed on the patient’s forehead or under the skin of the forehead and an electrical current is applied to the supraorbital nerves, a branch of the frontal nerve.
This passes through a branch of the frontal nerve, which then branches to the forehead, scalp, eye socket area, and frontal sinus. The stimulation of the supraorbital nerve has been proven helpful to those who are regular migraine sufferers. However, when supraorbital nerve stimulation is joined with occipital nerve stimulation, it provides a complete treatment for migraine relief.
What is Occipital Nerve Stimulation?
Occipital Nerve Stimulation (ONS) is a form of Neurostimulation, where a stimulator device is implanted under the skin that stimulates the spinal cord or nerves using a mild electromagnetic pulse. This treatment is used to reduce pain that radiates from the greater and lesser occipital nerves, located in the back of the head.
Patients consider this treatment option after other treatments, such as oral medications, have failed to provide relief. Developed by Dr. Kenneth L. Reed, ONS has been an FDA-approved treatment available since the early 1990s for certain types of pain syndromes. While not approved for head and facial pain specifically, it is considered an “off-label” use for treating migraine pain.
The Reed Procedure: Occipital and Supraorbital Nerve Stimulation
In 2004, Dr. Reed was the first physician to successfully combine both occipital and supraorbital stimulation for the treatment of migraine pain. A trial of 300 patients took place with very successful results. Over 80 percent of the patients experienced migraine pain reduction. In 2009 his publication on "Combined Peripheral Neurostimulation" received the "Cephalalgia Award" of the International Headache Society as the best original contribution of the year to the field.
The Reed Procedure – A Two-Step Process
The Reed Procedure involves the placement of a lead line under the skin near the great and lesser occipital nerves. These lines are then attached to an Implantable Pulse Generator (IPG), which is also placed under the skin. The location of the IPG can vary, but is most commonly placed in the chest, hip or back.
The patient uses an external device similar to a television remote to program the system via radio frequency. As the patient’s pain level changes, the system can be adjusted via the remote to manage the specific pain the patient is experiencing.
The effectiveness of The Reed Procedure will vary based on a patient needs, but it has been proven successful for a variety of different types of head and facial pain. The best candidate for The Reed Procedure is a patient that experiences frequent and severe migraines and treatments such as nerve blocks, medications, and other therapies that have been unsuccessful in providing relief.
Step One: The Trial Placement
The first step in The Reed Procedure is the trial placement. Lead lines are attached externally to the IPG, which is also placed externally. The patient is then provided with a remote that controls the pulses to the lead lines. Everything remains external for four to seven days while the patient is encouraged to go about their daily activities. During that time, patients are urged to attempt to “trigger” a migraine.
This could include participating in specific activities or eating foods that are considered triggers. This is not meant to cause pain to the patient, it’s the exact opposite. The purpose of the trial placement is to test the level of pain relief a patient may receive once the device is permanently implanted. This test plays a major role in determining if The Reed Procedure will be a successful pain management solution for the patient.
Step Two: Permanent Placement
If the trial placement is determined to be successful, a short one-hour surgery is scheduled for the permanent placement of the IPG and lead lines. A small incision at the base of the skull is made for the insertion of the lead lines. The lead lines are then attached subcutaneously to the IPG.
Post-operative care lasts approximately one hour. The patient then works with a medical professional to learn how to use the remote control in order to adjust the impulses for the best level of pain relief.
An important point to remember with The Reed Procedure is that there is no reason for concern of a stroke or brain damage. While The Reed Procedure includes a small incision at the back of the head, it is not placed within the skull or near the brain. The lead lines are placed outside the skull, just below the skin. Therefore, there is no risk of brain damage, spine damage, or stroke during or after the placement of The Reed Procedure ONS device.
The complete healing time for the permanent placement is approximately six weeks. During that time period, the patient should avoid strenuous activity, such as contact sports. After the initial six weeks, the patient may return to a normal routine and participate in any activity they wish. As patients gain better control over how to manage their migraine pain, they may decide to try activities that once caused pain and needed to be avoided.
While all surgeries come with risks, The Reed Procedure risks are minor. The most common risk of surgery is an infection, which occurs less than four percent of the time when the ONS placement is done by Reed Migraine Centers; this is well below the national average.
Other risks, although rare, include lead migration of the placement or lead fracture. This issue only occurs due to a sudden, and severe, trauma, such as a major car accident. Occasionally, the battery within the IPG may need to be replaced; however, this can take several years before replacement is required.
While The Reed Procedure is a successful option for many migraine sufferers, it isn’t the right solution for every patient. A consultation with a physician that is experienced in The Reed Procedure will work together with the patient to determine if ONS placement could prove helpful. The Reed Procedure has a high success rate for many different types of pain, including those who suffer from a chronic migraine.