255: Bilateral Pain Relief Achieved With Unilateral Occipital Peripheral Nerve Stimulation: Case series

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Non-pharmacological treatments, Neuromodulation (e.g. TMS, TDCS, FUS, SCS, MCS, DBS, vagus nerve stimulation), Pain in Special Populations

Background and Aims: Unilateral occipital nerve stimulation (ONS) may provide bilateral analgesia, but evidence is limited. We reviewed five patients with bilateral occipital neuralgia who received a 60‑day unilateral ONS lead at the C2–C3 junction. All experienced clinically meaningful improvement, with four reporting ≥75% bilateral pain reduction and decreased migraine burden. Several demonstrated sustained benefit for months after explant, including complete remission in two cases. Findings support modulation within the trigeminocervical complex and central pain networks as mechanisms for contralateral and durable analgesia.

Methods: We conducted a retrospective review of five patients with bilateral occipital neuralgia who underwent unilateral 60‑day occipital nerve stimulation (ONS). All procedures were performed under fluoroscopic guidance with lead placement at the ipsilateral C2–C3 junction. Sensory targeting was confirmed by paresthesia in the occipital nerve distribution. Clinical data were collected from baseline through follow‑up after explant. Primary outcomes included degree of pain reduction and laterality of effect. Secondary observations included changes in migraine frequency and durability of response. All patients provided consent for use of de‑identified clinical information; this review qualified as non‑human subjects research.

Results: All five patients experienced meaningful pain reduction with unilateral occipital nerve stimulation (ONS). Four reported ≥75% improvement in bilateral occipital pain, including resolution of sharp paroxysms and substantial reductions in migraine frequency. One patient achieved complete remission of head and neck pain. Three patients demonstrated sustained analgesia after lead explant, ranging from several weeks to over one year, with two maintaining near‑complete relief without additional preventive therapy. One patient had right‑sided site discomfort requiring right lead removal; the remaining unilateral lead still produced significant bilateral benefit. No infections or neurologic complications occurred.

Conclusions: Unilateral occipital nerve stimulation produced clinically meaningful bilateral analgesia in all five patients with bilateral ON, with most achieving ≥75% improvement and several demonstrating long‑term benefit after explant. These findings support the concept that unilateral peripheral neuromodulation can influence bilateral nociceptive pathways, likely through convergence within the trigeminocervical complex and modulation of central pain networks. A unilateral approach may reduce hardware burden, complication risk, and cost while maintaining therapeutic effectiveness. Larger prospective studies are needed to confirm efficacy, durability, and optimal patient selection for unilateral ONS in bilateral occipital neuralgia and chronic headache disorders.

References: Keifer OP et al. World Neurosurg. 2017.
Kollenburg L et al. Curr Pain Headache Rep. 2024.
Liu A et al. J Pain Res. 2017.
García‑Magro N et al. J Headache Pain. 2020.
Hoffmann J et al. J Neurol Neurosurg Psychiatry. 2021.
Buonocore M et al. PM&R. 2015.
Gutierrez GG et al. Headache. 2025.
Lin T et al. Pain Med. 2020.
Latif U et al. J Pain Res. 2025.
ICHD‑3. Cephalalgia. 2013.
Steiner TJ et al. Nat Rev Neurol. 2023.
Mathew PG et al. Neurol Clin Pract. 2021.

Presenting Author: Amanda Toye
Submitting Author: Amanda Toye

Senior Author: Tigran Kesayan

IASP 2026 Global Year theme of Neuropathic Pain: Yes