scholarly journals Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input

Brain ◽  
2002 ◽  
Vol 125 (7) ◽  
pp. 1496-1509 ◽  
Author(s):  
T. Bartsch
Keyword(s):  
Afferent Input ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Central Excitability ◽  
Stimulation Of

scholarly journals Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Byung-chul Son ◽  
Jin-gyu Choi
Keyword(s):  
Facial Pain ◽  
Afferent Input ◽  
Occipital Artery ◽  
Occipital Neuralgia ◽  
Unique Case ◽  
Occipital Nerve ◽  
Sensory Change ◽  
Greater Occipital Nerve ◽  
Upper Cervical ◽  
Stimulation Of

Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although referral of pain from the stimulation of occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic occipital neuralgia is extremely rare. Chronic continuous and strong afferent input of occipital neuralgia caused by pathological vascular contact with the greater occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures.

scholarly journals Modulation of mechanosensory vibrissal responses in the trigeminocervical complex by stimulation of the greater occipital nerve in a rat model of trigeminal neuropathic pain

2020 ◽  
Author(s):  
Nuria García-Magro ◽  
Pilar Negredo ◽  
Yasmina B. Martin ◽  
Angel Nuñez ◽  
Carlos Avendaño
Keyword(s):  
Nerve Stimulation ◽  
Facilitatory Effect ◽  
Mechanical Stimuli ◽  
Sensory Afferents ◽  
Occipital Nerve ◽  
Background Stimulation ◽  
Greater Occipital Nerve ◽  
Before And After ◽  
Male Wistar Rats ◽  
Stimulation Of

Abstract Background: Stimulation of occipital or trigeminal nerves has been successfully used to treat chronic refractory neurovascular headaches such as migraine or cluster headache, and painful neuropathies. Convergence of trigeminal and occipital sensory afferents in the "trigeminocervical complex" (TCC) from cutaneous, muscular, dural, and visceral sources is a key mechanism for the input-induced central sensitization that may underlie the altered nociception. Both excitatory (glutamatergic) and inhibitory (GABAergic and glycinergic) mechanisms are involved in modulating nociception in spinal and medullary dorsal horn neurons, but the mechanisms by which nerve stimulation effects occur are unclear. This study was aimed at investigating the acute effects of electrical stimulation of the greater occipital nerve (GON) on the responses of neurons in the TCC to the mechanical stimulation of the vibrissal pad.Methods: Adult male Wistar rats were used. Neuronal recordings were obtained in laminae II-IV in the TCC in control, sham and infraorbital chronic constriction injury (CCI-IoN) animals. GON was isolated and electrically stimulated. Responses to stimulation of vibrissae by brief air pulses were analyzed before and after GON stimulation. In order to understand the role of neurotransmitters involved, specific receptor blockers of NMDA (AP-5), GABAA (bicuculline, Bic) and Glycine (strychnine, Str) were locally applied.Results: GON stimulation produced a facilitation of the response to light facial mechanical stimuli in controls, and an inhibition in CCI-IoN cases. AP-5 reduced responses to GON and vibrissal stimulation and blocked the facilitation of GON on vibrissal responses found in controls. The application of Bic or Str reduced significantly the facilitatory effect of GON stimulation on the response to vibrissal stimulation in controls. However, the opposite effect was found when GABAergic or Glycinergic transmission was prevented in CCI-IoN cases.Conclusions: GON stimulation modulates the responses of TCC neurons to light mechanical input from the face in opposite directions in controls and under CCI-IoN. This modulation is mediated by GABAergic and Glycinergic mechanisms. These results will help to elucidate the neural mechanisms underlying the effectiveness of nerve stimulation in controlling painful craniofacial disorders, and may be instrumental for identifying new therapeutic targets for their prevention and treatment.

Low-Frequency Short-Time Nociceptive Stimulation of the Greater Occipital Nerve does not Modulate the Trigeminal System

Cephalalgia ◽  
2008 ◽  
Vol 28 (8) ◽  
pp. 842-846 ◽  
Author(s):  
TP Jürgens ◽  
V Busch ◽  
O Opatz ◽  
WJ Schulte-Mattler ◽  
A May
Keyword(s):  
Low Frequency ◽  
Blink Reflex ◽  
Trigeminal System ◽  
Nociceptive Stimulation ◽  
Drug Induced ◽  
Occipital Nerve ◽  
Nociceptive Blink Reflex ◽  
Greater Occipital Nerve ◽  
Short Time ◽  
Stimulation Of

Occipital stimulation in a small group of refractory chronic migraine and cluster headache patients has been suggested as a novel therapeutic approach with promising results. In an earlier study we have shown that a drug-induced block of the greater occipital nerve (GON) inhibits the nociceptive blink reflex (nBR). Now, we sought to examine the effects of low-frequency (3 Hz) short-time nociceptive stimulation of the GON on the trigeminal system. We recorded the nBR responses before and after stimulation in 34 healthy subjects. Selectivity of GON stimulation was confirmed by eliciting somatosensory evoked potentials of the GON upon stimulation. In contrast to an anaesthetic block of the occipital nerve, no significant changes of the R2-latencies and R2-response areas of the nBR can be elicited following GON stimulation. Various modes of electrical stimulation exist with differences in frequency, stimulus intensity, duration of stimulation and pulse width. One explanation for a missing modulatory effect in our study is the relatively short duration of the stimulation.

Reduction of Calcitonin Gene-Related Peptide in Jugular Blood Following Electrical Stimulation of Rat Greater Occipital Nerve

Cephalalgia ◽  
1992 ◽  
Vol 12 (5) ◽  
pp. 275-279 ◽  
Author(s):  
Maurice B Vincent ◽  
Rolf Ekman ◽  
Lars Edvinsson ◽  
Trond Sand ◽  
Ottar Sjaastad
Keyword(s):  
Electrical Stimulation ◽  
Calcitonin Gene Related Peptide ◽  
Trigeminal System ◽  
Occipital Nerve ◽  
Related Peptide ◽  
System Reduction ◽  
Calcitonin Gene ◽  
Greater Occipital Nerve ◽  
Ocular Signs ◽  
Stimulation Of

Although it is known that pain in the forehead may be induced by neck abnormalities, the actual neck-head connections responsible for development of pain in trigeminal areas are poorly understood. Vasoactive neuropeptides released from sensory fibres, such as substance P (SP) and calcitonin gene-related peptide (CGRP), have been considered as important elements in headache pathophysiology. The levels of CGRP-like immunoreactivity (LI) were measured bilaterally in the jugular blood (52 rats) and intraocular aspirates (66 rats) following electrical stimulation of the left greater occipital nerve, and in the jugular blood of 13 control animals. One-third of the stimulated rats had varying combinations of conjunctival injection, tearing, diminished eye aperture and miosis or mydriasis on the stimulated side. The other two-thirds exhibited no ocular signs. Significantly lower levels of CGRP-LI were present in the jugular blood on the stimulated side in comparison with control rats. There was comparatively lower CGRP-LI on the non-stimulated side as well, but to a lesser extent. Significant differences between the stimulated and the non-stimulated side were present, particularly in the tearing/diminished eye cleft group. It is proposed that stimulation of the rat GON inhibits the trigeminal system (reduction of CGRP-LI) and possibly activates parasympathetic fibres (ocular changes).

scholarly journals Stimulation of the Greater Occipital Nerve: Anatomical Considerations and Clinical Implications

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E181-E189 ◽  
Author(s):  
Oliver Mueller
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Trapezius Muscle ◽  
Anatomical Study ◽  
Chronic Cluster Headache ◽  
Individual Response ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Stimulation Of

Background: Stimulation of the greater occipital nerve has been employed for various intractable headache conditions for more than a decade. Still, prospective studies that correlate stimulation of the greater occipital nerve with outcome of patients with respect to alleviation of headache are sparsely found in literature. Objective: To identify anatomical landmarks for a reproducible stimulation of the greater occipital nerve. For the clinical implication, the individual response to therapy of patients with refractory chronic cluster headache undergoing occipital nerve stimulation was correlated with the postoperative localization of the electrodes and with the distribution of the stimulation field. Study Design: Prospective observational study, approved by the local research ethics board (09-4143). Setting: University hospital, departments of neurosurgery and neurology, institute of anatomy and radiology. Methods: Ten formaldehyde fixed human cadavers were dissected to identify the passage of the greater occipital nerve through the trapezius muscle. The distance to the external occipital protuberance was triangulated measuring the distance of the nerve from the nuchal midline and the protuberance. Between December 2008 and December 2011, 21 consecutive patients suffering from chronic cluster headache underwent surgery in terms of bilateral occipital nerve stimulation, with electrodes placed horizontally at the level of C1. The postoperative x-rays were compared with the acquired landmarks from the anatomical study. The distribution of the stimulation field was correlated to the individual response of each patient to the therapy and prospectively analyzed with regard to reduction of daily cluster attacks and relief of pain intensity at 3 months and at last follow-up. Results: The greater occipital nerve crosses the trapezius muscle at a mean distance of 31mm below the occipital external protuberance and 14mm lateral to the midline as found in the anatomical subjects. The electrodes were targeted at this level in all of our patients and stimulated the greater occipital nerve in all patients. Eighteen of the patients (85.7%) reported a significant reduction of the frequency of their cluster attacks and/or declined intensity of pain during the attacks. Yet, 3 of 21 patients (14.3%) did not benefit from the stimulation despite an adequate spread of the stimulation over the occiput. The spread of the stimulation-induced paraesthesias over the occiput was not correlated to a reduction of cluster attacks, to the intensity of attacks, or to the response to treatment at all. Limitations: Single center non-randomized non-blinded study. Conclusions: From our study we conclude that a reproducible stimulation of the greater occipital nerve can be achieved by placing the electrodes parallel to the atlas, at about 30mm distance to the external occipital protuberance. The response to the stimulation is not correlated to the field width of the paraesthesia. We, therefore, consider stimulation of the main trunk of the greater occipital nerve to be more important than a large field of stimulation on the occiput. Still, an individual response to the occipital nerve stimulation cannot be predicted even by optimal electrode placement. Key words: Greater occipital nerve, occipital nerve stimulation, anatomical study, chronic cluster headache

scholarly journals V2 Trigeminal Referred Pain from Chronic Occipital Neuralgia Caused by Entrapment of the Greater Occipital Nerve

2019 ◽  
Vol 08 (01) ◽  
pp. 076-080 ◽  
Author(s):  
Chang-ik Lee ◽  
Byung-chul Son
Keyword(s):  
Female Patient ◽  
Afferent Input ◽  
Referred Pain ◽  
Occipital Neuralgia ◽  
Upper Lip ◽  
Occipital Nerve ◽  
Burning Pain ◽  
Trigeminal Pain ◽  
Greater Occipital Nerve ◽  
New Onset

AbstractAlthough entrapment of the greater occipital nerve (GON) is a well-known cause of occipital neuralgia, occurrence of referred hemifacial trigeminal pain involving V2 distribution from chronic occipital neuralgia is rare. A 67-year-old female patient with intermittent left-sided occipital neuralgia of 10-year duration presented with a new onset of left-sided hemifacial pain of 5-month duration. With aggravation of left-sided occipital neuralgia, continuous burning pain and paresthesia gradually developed in her left malar and periorbital area. They also spread to her left upper lip. Severe compression of the left GON by tendinous aponeurotic attachment of the trapezius was found intraoperatively. Decompression of the left GON from chronic entrapment resulted in immediate relief for her hemifacial pain and chronic occipital neuralgia. These findings provide clinical affirmation of the existence of trigeminal/cervical convergence and hypersensitivity. Chronic irritating afferent input of occipital neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex receiving convergent input from dural and cervical structures. Referred trigeminal pain from chronic occipital neuralgia may extend to V2 in addition to V1 trigeminal distribution.

Occipital Neuralgia

2019 ◽  
pp. 51-64
Author(s):  
Richard L. Weiner
Keyword(s):  
Occipital Neuralgia ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Cervical Roots ◽  
Stimulation Of

Patients with occipital neuralgia typically complain of intractable, posterior headaches. Prior attempts to treat this condition have traditionally consisted of various strategies to decompress or cut the greater occipital nerve. Some have even advocated the ablation of ganglia or cervical roots that give rise to the occipital nerve. However, such treatments are highly invasive, irreversible, and fraught with failure and complications. Modern strategies employing subcutaneous stimulation of the occipital nerve using linear stimulation arrays are quite effective and lower in invasiveness and risk. This chapter discusses the clinical hallmarks of occipital neuralgia and the technique by which these subcutaneous electrodes are implanted and utilized.

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