scholarly journals Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

2021 ◽  
Author(s):  
Roemer B. Brandt ◽  
Patty G. G. Doesborg ◽  
Roy Meilof ◽  
Ilse F. de Coo ◽  
Eveline Bartels ◽  
...  
Keyword(s):  
Side Effects ◽  
Cluster Headache ◽  
Clinical History ◽  
Routine Care ◽  
Chronic Cluster Headache ◽  
Occipital Nerve ◽  
Headache Centre ◽  
Prophylactic Drugs ◽  
Greater Occipital Nerve ◽  
Effect Duration

Abstract Introduction Current prophylactic drugs for cluster headache are associated with limited efficacy, serious side effects and poor tolerability. Greater occipital nerve injection (GON-injection) has been proven effective and safe as a single, one-time injection in episodic (ECH), and to a lesser extent, chronic cluster headache (CCH). We aim to analyse the effectiveness and safety of repeated GON-injections in medically intractable chronic cluster headache (MICCH). Methods Clinical data of all cluster headache patients who had received at least one GON-injection between 2014 and 2018 in our tertiary headache centre were retrieved from patients’ medical records. Clinical history was taken as part of routine care shortly before and 6 weeks after GON-injection. Results We identified 47 MICCH patients (79 injections), and compared results with 22 non-MI CCH patients (30 injections) and 50 ECH patients (63 injections). Nineteen MICCH patients received repeated injections (32 in total, range 2–8). Rates of clinical relevant improvement to a first injection were similar in all groups (MICCH: 60%, non-MICCH 73%, ECH 76%; attack freedom: MICCH: 30%, non-MICCH 32%, ECH 43%). Furthermore, no difference in response to the first and second injection was shown between groups (all p > 0.29). Median effect duration in MICCH was 6 weeks (IQR 2.8–12 weeks). Side effects were only mild and local. Conclusion In this retrospective analysis, first and repeated GON-injections were well-tolerated and equally effective in MICCH as in non-MICCH, and ECH.

Efficacy and safety of 121 injections of the greater occipital nerve in episodic and chronic cluster headache

Cephalalgia ◽  
2012 ◽  
Vol 32 (8) ◽  
pp. 630-634 ◽  
Author(s):  
Andreas R Gantenbein ◽  
Nina J Lutz ◽  
Franz Riederer ◽  
Peter S Sándor
Keyword(s):  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Efficacy And Safety ◽  
Occipital Nerve ◽  
Greater Occipital Nerve

Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation

Cephalalgia ◽  
2011 ◽  
Vol 31 (10) ◽  
pp. 1101-1105 ◽  
Author(s):  
Denys Fontaine ◽  
Jean Christophe Sol ◽  
Sylvie Raoul ◽  
Nelly Fabre ◽  
Gilles Geraud ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Prophylactic Treatment ◽  
International Headache Society ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
International Headache Society Classification

Background: Greater occipital nerve stimulation (ONS) has been recently proposed to treat severe chronic cluster headache patients (CCH) refractory to medical treatment. We report the results of a French multidisciplinary cohort study. Methods: Thirteen CCH patients were operated and data were collected prospectively. All of them suffered from CCH according to the International Headache Society classification, lasting for more than 2 years, refractory to pharmacological prophylactic treatment with adequate trials, with at least one daily attack. Chronic ONS was delivered through a subcutaneous occipital electrode connected to an implanted generator, in order to induce paraesthesias perceived locally in the lower occipital region. Results: After surgery (mean follow-up 14,6 months), the mean attack frequency and intensity decreased by 68% and 49%, respectively. At last follow-up, 10/13 patients were considered as responders (improvement >50%). Prophylactic treatment could be stopped or reduced in 8/13 cases. Local infection occurred in one patient, leading to hardware removal. Conclusions: Our data confirmed the results of the 36 similar cases reported in the literature, suggesting that ONS may act as a prophylactic treatment in chronic CH. Considering their respective risks, ONS should be proposed before deep brain stimulation in severe refractory CCH patients.

scholarly journals Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study

2021 ◽  
Author(s):  
Elena Merli ◽  
Gian Maria Asioli ◽  
Valentina Favoni ◽  
Corrado Zenesini ◽  
Davide Mascarella ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Chronic Patients ◽  
Steroid Injections ◽  
Occipital Nerve ◽  
First Choice ◽  
Greater Occipital Nerve ◽  
Long Acting ◽  
Headache Patients

Abstract Background Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection regimens. The aim of this study was to verify the effectiveness and safety of greater occipital nerve long-acting steroid injections in the management of episodic and chronic cluster headache. Methods We conducted a prospective observational cohort study on episodic (ECH) and chronic cluster headache patients (CCH). ECH were included in the study at the beginning of a cluster period. Three injections with 60 mg methylprednisolone were performed on alternate days. We registered the frequency and intensity of attacks three days before and 3, 7 and 30 days after the treatment, the latency of cluster relapse, adverse events, scores evaluating anxiety (Zung scale), depression (Beck’s Depression Scale) and quality of life (Disability Assessment Schedule II, 12-Item Self-Administered Version). Primary outcome was the interruption of the cluster after the three injections. Responders conducted a follow-up period of 12 months. Results We enrolled 60 patients, 47 with ECH and 13 with CCH. We observed a complete response in 47.8% (22/46) of episodic and 33.3% (4/12) of chronic patients. Moreover, a partial response (reduction of at least 50% of attacks) was obtained in further 10.8% (5/46) of episodic and in 33.3% (4/12) of chronic patients at 1 month. Median pain-free period was of 3 months for CCH responders. Only mild adverse events were reported in 38.3% (23/58) cases. Conclusions We suggest three greater occipital nerve injections of 60 mg methylprednisolone on alternate days as useful therapy in episodic and chronic cluster headache. This leads to a long pain-free period in chronic forms. Adverse effects are mild and support its use as first choice. Trial registration The study was inserted in AIFA observational studies register.

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

Greater occipital nerve blocks in chronic cluster headache: a prospective open-label study

2013 ◽  
Vol 21 (2) ◽  
pp. 338-343 ◽  
Author(s):  
G. Lambru ◽  
N. Abu Bakar ◽  
L. Stahlhut ◽  
S. McCulloch ◽  
S. Miller ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Open Label ◽  
Nerve Blocks ◽  
Open Label Study ◽  
Label Study ◽  
Occipital Nerve ◽  
Greater Occipital Nerve

Occipital Nerve Blockade in Chronic Cluster Headache Patients and Functional Connectivity Between Trigeminal and Occipital Nerves

Cephalalgia ◽  
2007 ◽  
Vol 27 (11) ◽  
pp. 1206-1214 ◽  
Author(s):  
V Busch ◽  
W Jakob ◽  
T Juergens ◽  
W Schulte-Mattler ◽  
H Kaube ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Cluster Headache ◽  
Clinical Symptoms ◽  
Blink Reflex ◽  
Chronic Cluster Headache ◽  
Nerve Blockade ◽  
Occipital Nerve ◽  
Nociceptive Blink Reflex ◽  
Greater Occipital Nerve ◽  
Headache Patients

Headache syndromes often involve occipital and neck symptoms, suggesting a functional connectivity between nociceptive trigeminal and cervical afferents. Although reports regarding effective occipital nerve blockades in cluster headache exist, the reason for the improvement of the clinical symptoms is not known. Using occipital nerve blockade and nociceptive blink reflexes, we were able to demonstrate functional connectivity between trigeminal and occipital nerves in healthy volunteers. The R2 components of the nociceptive blink reflex and the clinical outcome in 15 chronic cluster headache patients were examined before and after unilateral nerve blockade of the greater occipital nerve with 5 ml prilocain (1%) on the headache side. In contrast to recent placebo-controlled studies, only nine of the 15 cluster patients reported some minor improvement in their headache. Six patients did not report any clinical change. Exclusively on the injection side, the R2 response areas decreased and R2 latencies increased significantly after the nerve blockade. These neurophysiological and clinical data provide further evidence for functional connectivity between cervical and trigeminal nerves in humans. The trigeminocervical complex does not seem to be primarily facilitated in cluster headache, suggesting a more centrally located pathology of the disease. However, the significant changes of trigeminal function as a consequence of inhibition of the greater occipital nerve were not mirrored by a significant clinical effect, suggesting that the clinical improvement of occipital nerve blockades is not due to a direct inhibitory effect on trigeminal transmission.

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