Programming the ONS neuromodulation device for chronic migraine

At the Migraine and Headache Center of the Kiel Pain Clinic, we have introduced a specialized consultation for the care of patients with severe, therapy-resistant forms of migraine and other chronic pain diseases, for which occipital nerve stimulation (ONS) or other neuromodulation procedures were necessary for treatment. Depending on individual requirements, an implanted neurostimulator for peripheral nerve stimulation can be reprogrammed on an outpatient or inpatient basis. Experts at the Kiel Pain Clinic have special certification for operating and reprogramming neurostimulation systems. The aim is to ensure an optimal individual effect of the neurostimulation system. The patients receive a series of different parameter combinations individually programmed by a doctor. The position of the electrodes as well as the individual anatomical peculiarities of the patient are taken into account. The individual sensory aspects of the stimulation must be determined and individually adjusted and recorded for an optimal stimulation effect. Experience has shown that reprogramming must be carried out in individual cases during the postoperative course after re-implantation of the neurostimulation system in order to adapt the parameters to the course of treatment. To carry out the reprogramming, an appointment can be made directly by telephone as part of the neuromodulation consultation by calling 0431-20099400.

Neuromodulation

There are only a few effective treatment options for particularly severely affected patients with chronic migraines and other severe chronic pain. Standard therapy procedures are usually without lasting effectiveness. Recently, peripheral nerve stimulation (PNS) has come into focus as a treatment option. Peripheral nerve stimulation is a specific application of neuromodulation. Successful use is possible for headaches, back pain, neck pain, arm and leg pain. Due to the increasing progress of microelectronics, it is possible to implant a pacemaker-like device under the skin and thus enable continuous neuromodulation. The device is about the size of a matchbox. The implantation of the neurostimulator is carried out in cooperation with the neurosurgery clinics at the University Hospital Schleswig-Holstein. The indication, pre- and follow-up care, programming as well as progress and success monitoring are carried out by experts from the Kiel Pain Clinic.

Neurostimulation device and ONS electrodes
ONS electrodes are implanted
Insertion of the connecting cables to the stimulator
Electrodes and cables are connected
Stimulator connection
Checking the system during the operation
Closure of the skin accesses
Checking the electrode position after the ONS operation
Fine adjustment of the stimulation in the Kiel pain clinic
Programming of the 16 electrodes in the Kiel pain clinic

To treat chronic migraines, a special rechargeable system can be implanted, meaning there is no need to change the battery. The stimulator sends electrical signals to the occipital nerve (ON), located just under the skin of the neck. Due to this special location, the treatment option is also called occipital nerve stimulation (ONS). The mode of action of occipital nerve stimulation is explained by changes in electrical regulation in the brainstem. The pattern of pain signals is modulated and masked by continuous stimulation. The constant hypersensitivity in the nervous system is balanced and reduced. The function of the neurostimulator system and the peripheral nerve stimulation can be compared to that of the pacemaker. It is assumed that neuromodulation activates and stabilizes the body's own defenses against pain, thus naturally reducing sensitivity to pain signals. The individual steps of implanting the system and further details can be found here .

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