Diagnosis; headaches/trigeminal neuralgia
Treatment: Electrical Stimulator for the Nerves Near the Base of Head
The insurer denied an Electrical Stimulator for the Nerves Near the Base of Head. The health plan's determination is upheld.

This is a male with a 20-year history of occipital and trigeminal neuralgia. He has had injections and medications without relief. The neurologic exam shows no abnormalities. The brain magnetic resonance imaging (MRI) shows vascular contact of the SCA (superior cerebellar artery) with the trigeminal nerve. The provider has recommended an occipital nerve stimulator trial.

The Electrical Stimulator for the Nerves Near the Base of Head is not medically necessary for this patient.
Based on the current medical literature, occipital nerve stimulation for occipital neuralgia or headaches would be considered not medically necessary. While this is a promising technology, the current literature relates that further studies are needed to show the efficacy of the procedure. This process may require additional studies, at least for approval from the US (United States) Food and Drug Administration. There are still concerns over the risk to benefit ratio and effectiveness of ONS (occipital nerve stimulation) despite positive open-label data and a well-designed double-blind controlled trial with long-term follow-up is needed to clarify the position of neuromodulation in chronic migraine.