There are multiple ways in which occipital nerve stimulation works. Although these mechanism are not completely understood, they include: • Subcutaneous electrical conduction • Dermatomal stimulation • Myotomal stimulation • Sympathetic stimulation • Local blood flow alteration • Peripheral nerve stimulation • Peripheral and central neurochemical mechanisms • Trigeminovascular system and Trigeminocervical tract Paresthesia patterns and pain relief obtained from occipital nerve stimulation works by altering the activity (electrical or chemical) of the central, peripheral or autonomic nervous system by the process of inhibition, stimulation or modification. One of the theories by which the mechanism of action of occipital nerve stimulation works is gate control theory. Stimulation activates large myelinated afferents fibers, which “close the pain gate” in the substantia gelatinosa in the dorsal horn of spinal cord. This results in inhibition of free nerve endings and since pain is maintained by continuous firing of myelinated afferents fibers, increase in their activation closes the gate and stops pain transmission.

There are multiple ways in which occipital nerve stimulation works. Although these mechanism are not completely understood, they include: • Subcutaneous electrical conduction • Dermatomal stimulation • Myotomal stimulation • Sympathetic stimulation • Local blood flow alteration • Peripheral nerve stimulation • Peripheral and central neurochemical mechanisms • Trigeminovascular system and Trigeminocervical tract Paresthesia patterns and pain relief obtained from occipital nerve stimulation works by altering the activity (electrical or chemical) of the central, peripheral or autonomic nervous system by the process of inhibition, stimulation or modification. One of the theories by which the mechanism of action of occipital nerve stimulation works is gate control theory. Stimulation activates large myelinated afferents fibers, which “close the pain gate” in the substantia gelatinosa in the dorsal horn of spinal cord. This results in inhibition of free nerve endings and since pain is maintained by continuous firing of myelinated afferents fibers, increase in their activation closes the gate and stops pain transmission.