Mary Kay Swift, R.N., the clinical coordinator at the clinic in Dallas, tells me that diagnosis for patients with headaches that begin in the back of the head (the occiput) is accomplished by a block of the occipital nerve to make sure it is the source of the pain.
The physicians inject a little local anesthetic and steroid around this nerve in the back of the head. If within the next three days the patient experiences relief of at least half of his pain, the doctors know the occipital nerve is the source of some part of his pain. If not, of course, they must look elsewhere.
The patient with positive results then moves on to an outpatient procedure in the clinic's operating room to have an electrode inserted into his head. (This isn't nearly as gory as it sounds and won't turn you into Frankenstein.) The surgeon stimulates the electrode until the patient feels a tingling sensation where the pain normally begins. He goes home with a dressing covering the electrode lead, and a hand-held programmer with which he can adjust the amount of stimulation.
This time the patient returns about a week later. Again, if he has experienced at least 50% pain relief, he is a candidate for a permanent implant.
The permanent generator is about the same size as a pacemaker and is implanted in the same way. The surgeon places it under the skin of the abdomen and gives the patient a transmitter to adjust the rate of stimulation by placing it over the generator. It gives the patient control over his headaches with a device sort of like adjusting the volume on his television set with a remote control.
Swift tells me the generators usually last between three and four years, depending on how much they are used, and then must be replaced. There are different types, all of them quite expensive at about $8,000 to $12,000. In addition of course, there are the physician and hospital fees. However, their patients' insurance policies have covered this expense.
There are other methods of occipital stimulation and other pain management centers which do the procedure. In answer to my question, Swift reminded me that this is only for pain which originates in the back of the head. For arthritis sufferers like me whose pain originates in the neck, there are similar cervical procedures available if and when I reach the time when medication and exercise don't control it well enough.
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