The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Occipital nerve stimulation for intractable chronic migraine.


A migraine is a severe headache usually felt as a throbbing pain at the front or on one side of the head. Some people also have other symptoms, such as nausea and sensitivity to light. Occipital nerve stimulation involves implanting electrodes, an impulse generator and connecting insulated wires under the skin. The electrodes are implanted near the occipital nerve located just beneath the skin at the back of the head and the impulse generator is usually implanted at a site in the torso. The patient uses a remote control to deliver electrical impulses to the occipital nerve with the aim of masking the pain.

Coding recommendations

Stage 1

A70.4 Insertion of neurostimulator electrodes into peripheral nerve

Y70.5 Temporary operations

Y70.3 First stage of staged operations NOC

Y53.4   Approach to organ under fluoroscopic control (if fluoroscopic control has been used)

Z92. 1 Head  NEC

Stage 2

A70.1 Implantation of neurostimulator into peripheral nerve

Y71.1 Subsequent stage of staged operations NOC

Y53.4   Approach to organ under fluoroscopic control (if fluoroscopic control has been used)

Z92.1 HeadNEC

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)