Dr. Brian Snyder Uses Occipital Nerve Stimulation When Medications Fail
ROCKVILLE CENTRE, NY – Fox 5 New York/WNYW-TV reporter Ashley Mastronardi reported November 12 on a promising new surgical treatment for chronic migraine being performed by neurosurgeon Brian J. Snyder, M.D. The story featured Dr. Snyder’s patients Megan Doscher and Cori Borsack, both of whom suffered from excruciating daily migraines. Thanks to the ground-breaking procedure, performed by Dr. Snyder at Winthrop-University Hospital, both have regained control of their lives, with significant reductions in their migraines.
Known as occipital nerve stimulation, the procedure significantly decreases the severity and frequency of headaches in patients suffering from debilitating chronic migraines. The treatment is used when medical therapies fail to provide relief.
“Many suffer daily with severe migraines, without relief,” says Dr. Snyder, an attending neurosurgeon with Neurological Surgery, P.C. (NSPC). “Occipital nerve stimulation has been studied extensively, and can provide significant relief to patients whose migraines do not respond to medication.”
A large-scale randomized multi-center, placebo-controlled study published in the December 2012 issue of Cephalalgia, the journal of the International Headache Society, reports the latest positive results. Chronic migraine patients in the study who received this procedure showed significant reductions in pain, headache days, and migraine-related disability. The study was sponsored by St. Jude Medical.
Occipital nerve stimulation involves delivering a small electrical charge over the region of the occipital nerves through an implanted device. The device resembles a cardiac pacemaker, except that it is used to stimulate nerves overlying the skull rather than the heart. It is implanted in the chest wall like a cardiac pacemaker and controlled via a remote control device. The doctor uses a programmer to set up the stimulation programs.
The device is first tried using temporary leads. Adjustments are then made, and if the device works well for the patient, permanent leads are implanted a week later. Recuperation time is brief.
In the procedure, electrodes are placed under the skin but over the skull in the region where the occipital nerves — peripheral nerves that transmit feeling to the top and back of the head — run. Patients may experience a pleasant tingling sensation. While the exact mechanism of relieving headache pain remains uncertain, scientists believe the stimulation influences centers within the brain responsible for the generation of headache pain.
There are currently three large-scale randomized, placebo-controlled trials of occipital nerve stimulation, the largest being the Occipital Nerve Stimulation for the Treatment of Intractable Migraine (ONSTIM) study, sponsored by Medtronic. Preliminary findings from ONSTIM were published in 2010, showing significant migraine relief for severely debilitated patients who regularly experienced headaches for 15 days or more a month and were not responsive to medical therapies.
A number of nerve stimulators, known as “neurostimulation” or “neuromodulation” devices, are currently on the market. These devices are FDA approved for various neurostimulation uses, but are not yet cleared for occipital nerve stimulation. The government allows their use “off-label” if the physician feels it is in the patient’s best interest and they are approved for other uses. Occipital nerve stimulation has been in use since the 1990s, and has been studied extensively.
“Many patients with chronic migraines and other types of pain who are not responsive to non-surgical treatment may benefit from neurostimulation devices,” says Dr. Snyder. “This is an important new treatment option.”
According to the American Migraine Foundation, 36 million Americans suffer from migraines. Migraines are three times more common in women than in men, and nearly a third of women experience migraine in their lifetimes. The World Health Organization places migraine as one of the top 20 disabling conditions on the planet, and chronic migraine is even more disabling. Chronic migraine, which affects 3.2 million Americans, is a severely debilitating headache that occurs 15 or more days a month for at least six consecutive months.
Brian J. Snyder, M.D. is a neurosurgeon who specializes in treating chronic pain, seizure disorders and epilepsy, as well as movement disorders such as Parkinson’s disease, tremor and dystonia. He is a leading practitioner of deep brain stimulation (DBS), having trained under Dr. Andres Lozano, perhaps the world’s foremost DBS authority. He also has extensive expertise in vagal nerve stimulation and procedures for mapping, recording and identifying seizure foci in the brain, and in the surgical resection of these foci. Dr. Snyder uses a number of types of neuromodulation techniques and devices for chronic pain, including spinal cord stimulation, peripheral nerve stimulation (including occipital nerve stimulation), deep brain stimulation and implantable drug pumps. He is certified in both Gamma Knife® and CyberKnife® radiosurgery.