What Is Occipital Nerve Stimulation?

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Occipital nerve stimulation, also known as peripheral nerve stimulation, is a surgical procedure used to treat chronic headaches and facial pain that does not respond to other kinds of pain-relief therapy. Pain management is essential for those with a headache disorder to maintain a healthy quality of life. Occipital nerve stimulation is a last-resort procedure after other, less invasive therapies have failed.

This article provides an overview of occipital nerve stimulation, the conditions it may treat, how to prepare for the procedures, and outcomes.

Man with pain in occipital area of neck

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What Is Occipital Nerve Stimulation?

Occipital nerve stimulation is a therapy that involves placing an implantable device at the base of the skull of a person with unmanageable and chronic head and craniofacial pain.

The device contains two parts, which are:

  • An electrode: A device that is placed at the base of the skull in the tissues associated with the greater and lesser occipital nerves
  • A pulse generator: The power source (usually placed in the collar bone, anus, or abdomen) which sends electrical impulses directly to the occipital nerve

Before receiving a permanent implant, the patient must undergo a trial under sedation. Leads (conveying wires) are placed and connected to a battery outside of the patient during the trial. It usually only takes a few hours, and the patient goes home the same day.

For the next four to seven days, the patient must keep a pain diary to see if the trial was beneficial and if the pain is reduced. The patient might be a good candidate for a permanent occipital nerve stimulation implant if there was significant pain reduction.

A permanent occipital nerve stimulation device is usually placed under general anesthesia. It is an outpatient procedure, and the patient goes home the same day. Complete healing usually takes about six weeks.

How Common Are Headaches and Face Pain?

Headache and craniofacial pain are two of the most commonly reported ailments globally. According to the World Health Organization (WHO), up to one in 20 adults has a headache every or nearly every day.

What Conditions Can Occipital Nerve Stimulation Treat?

Occipital nerve stimulation treats patients with chronic and disabling headache disorders, such as:

Who Has This Procedure?

Not every patient is a candidate for occipital nerve stimulation, even those with chronic headaches.

Initial treatment for headaches and craniofacial pain typically includes oral medications that may be prescribed to prevent or treat acute pain attacks.

The use of occipital nerve stimulation is usually reserved for chronic neuropathic pain disorders that do not resolve with more conservative therapies. Also, the source of pain must originate from specific peripheral nerve pathways.

Researchers do not entirely understand why occipital nerve stimulation works, but they believe it may be due to the "activation" of pain-modulation pathways.

Expected Outcomes

Patients who receive occipital nerve stimulation are thoroughly screened and go through a trial to see if they are an appropriate candidate for the therapy. The thorough selection process may be why the pain reduction success rate is so positive.

One study that examined the results of 53 patients who had occipital nerve stimulating therapy for chronic migraines found that after having the procedure:

  • 45.3% of patients had a 30% reduction in monthly moderate-to-severe headache days.
  • 37.7% had a reduction of 50% or more in monthly moderate-to-severe headache days.

Patients also reported:

  • Reductions in pain intensity
  • Reduced pain duration
  • Reduced headache-related disability
  • Improved quality of life

The research noted that out of the 53 patients, there was just one minor post-procedure infection.


Occipital nerve stimulation implants are usually outpatient procedures, and the patient usually goes home the same day. However, some patients may stay in the hospital for one night. Complete healing usually takes about six weeks.

Warnings and Contraindications

There is always some risk to every type of surgical procedure. Although rare, possible complications of this surgery may include:

  • Infection
  • Bleeding from the wound
  • Headaches
  • Device failure
  • Allergic reactions to drugs given during or after the procedure

In addition, there is a chance that the occipital nerve stimulation implant will not have any effect on your headaches. In some cases, it may be possible that the device stimulates the wrong area. Talk to your healthcare provider about the next steps if this occurs.

Tracking Your Pain

It's essential to keep a pain diary to record the head pain and changes in pain that you experience following the procedure to understand how your occipital nerve stimulating device manages your pain. You may also want to treat it as a "headache journal," to see if you can spot any headache triggers, such as foods, smells, or events that precipitate a headache.


Occipital nerve stimulation is a procedure that implants a device with electrodes near the occipital lobe that can stimulate nerves to help manage head pain. It is used as a treatment option for headaches and face pain, performed only after other treatment options have failed. It can be successful in reducing the number of headache days per month in individuals with headache disorders. There are very few side effects from the procedure, and the healing process takes about six weeks.

A Word From Verywell

Chronic headaches and pain can be excruciating and negatively affect your quality of life. Fortunately, there are several types of therapies that may help. Occipital nerve stimulation is only a last resort after many other less invasive and often successful treatment options. Talk to your healthcare provider about treatments that are right for you to find relief from chronic head pain.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lambru G, Matharu MS. Occipital nerve stimulation in primary headache syndromesTher Adv Neurol Disord. 2012;5(1):57-67. doi:10.1177/1756285611420903

  2. World Health Organization. Headache disorders: how common are headaches?.

  3. Zhou S, Hussain N, Abd-Elsayed A, et al. Peripheral nerve stimulation for treatment of headaches: an evidence-based review. Biomedicines. 2021;9(11):1588. doi:10.3390/biomedicines9111588

  4. Miller S, Watkins L, Matharu M. Long-term outcomes of occipital nerve stimulation for chronic migraine: a cohort of 53 patientsJ Headache Pain. 2016;17(1):68. doi:10.1186/s10194-016-0659-0

By Sarah Jividen, RN
Sarah Jividen, RN, BSN, is a freelance healthcare journalist and content marketing writer at Health Writing Solutions, LLC. She has over a decade of direct patient care experience working as a registered nurse specializing in neurotrauma, stroke, and the emergency room.