Occipital Nerve Stimulation for Refractory Chronic Cluster Headache: A Cost‐Effectiveness Study

2021 ◽  
Author(s):  
Julie Bulsei ◽  
Aurélie Leplus ◽  
Anne Donnet ◽  
Jean Regis ◽  
Christian Lucas ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cluster Headache ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Effectiveness Study ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Cost Effectiveness Study

scholarly journals Burst Occipital Nerve Stimulation for Chronic Migraine and Chronic Cluster Headache

2019 ◽  
Vol 22 (5) ◽  
pp. 638-644 ◽  
Author(s):  
Rodrigo Garcia‐Ortega ◽  
Tamara Edwards ◽  
Liz Moir ◽  
Tipu Z. Aziz ◽  
Alexander L. Green ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve

Occipital nerve block prior to occipital nerve stimulation for refractory chronic migraine and chronic cluster headache: Myth or prediction?

Cephalalgia ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 359-362 ◽  
Author(s):  
Thomas M Kinfe ◽  
Patrick Schuss ◽  
Hartmut Vatter
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Nerve Block ◽  
Nerve Stimulation ◽  
Predictive Value ◽  
Positive Response ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Occipital Nerve Block

Background Occipital nerve stimulation (ONS) results in beneficial outcomes, with marked pain relief, in otherwise intractable chronic migraine (CM) and chronic cluster headache (CCH). Some studies have reported that a positive response to occipital nerve block (ONB) administered prior to ONS predicts a positive response to ONS. However, other studies concerned with proper patient selection claimed no predictive value for ONB. The aim of this study was to re-evaluate the usefulness and predictive value of ONB prior to ONS. Methods Literature searches on the predictive value of ONB were performed in MEDLINE and PubMed. Patient data were extracted and a pooled analysis was performed. Results The literature review revealed 133 patients with CM and seven patients with CCH who received preoperative ONB. To date, a randomized controlled study examining the relationship between ONB and ONS has not been conducted in patients with CM. Conclusions Current literature suggests that ONB does not sufficiently predict ONS responsiveness in patients with refractory CM and CCH; this important issue requires further investigation.

High cervical spinal cord stimulation for chronic cluster headache

Cephalalgia ◽  
2011 ◽  
Vol 31 (11) ◽  
pp. 1170-1180 ◽  
Author(s):  
Tilman Wolter ◽  
Andrea Kiemen ◽  
Holger Kaube
Keyword(s):  
Spinal Cord ◽  
Cluster Headache ◽  
Nerve Stimulation ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
The Mean ◽  
High Cervical

Background: Cluster headache (CH) is the most painful and debilitating primary headache syndrome. Conventional treatment combines acute and prophylactic drugs. Also with maximal therapy a substantial proportion of patients do not experience a meaningful prevention or pain relief. Recent case series and early trials have suggested that occipital nerve stimulation can be very effective in the management of intractable CH. Methods: Seven patients with medically intractable chronic cluster headache were implanted with high cervical epidural electrodes. After a median test phase of 10 days (range 4–19 days) an impulse generator was implanted subcutaneously. Mean follow up was 23 months (median 12 months, range 3–78 months). Results: All patients showed significant treatment effects. In all patients, improvement occurred immediately after electrode implantation. The mean attack frequency decreased, as well as the mean duration and intensity of attacks. Also, depression, anxiety, and pain-related impairment scores decreased and medication intake was markedly reduced. Conclusions: In this prospective series, high cervical spinal cord stimulation shows an effect size equal or larger than occipital nerve stimulation with immediate onset after surgery and may serve as a valuable additional treatment option of intractable cluster headache in the future.

Occipital nerve stimulation for intractable chronic cluster headache or migraine: A critical analysis of direct treatment costs and complications

Cephalalgia ◽  
2013 ◽  
Vol 33 (16) ◽  
pp. 1283-1291 ◽  
Author(s):  
Oliver Mueller ◽  
Hans-Christoph Diener ◽  
Philipp Dammann ◽  
Kasja Rabe ◽  
Vincent Hagel ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Treatment Costs ◽  
Headache Disorders ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Primary Headache Disorders ◽  
Direct Treatment ◽  
Hospitalization Costs

Background Occipital nerve stimulation (ONS) has been shown to be effective for selected patients with intractable headache disorders. We performed a prospective critical evaluation of complications and direct treatment costs. Methods Twenty-seven patients with chronic cluster headache (CCH, n = 24) or chronic migraine (CM, n = 3) underwent a trial phase with bilateral ONS and subsequent implantation of a permanent generator (IPG), if responsive to treatment according to predefined criteria. Procedural and long-term complications as well as direct treatment costs of neuromodulation therapy of ONS were recorded over a mean follow-up period of 20 months (range 5–47 months). Results Twenty-five of 27 patients (93%) responded to treatment. Twenty-one complications in 14 patients were identified, necessitating reoperation in 13 cases. Overall treatment costs were €761,043, including hardware-related costs of €506,019, costs for primary hospital care of €210,496, and complications related to hospitalization costs of €44,528. This results in a per case-based cost of €9445 for hospitalization and €18,741 for hardware costs, totaling €28,186. Conclusion ONS for treatment of refractory CCH and CM is a cost-intensive treatment option with a significant complication rate. Nevertheless, patients with refractory primary headache disorders may experience substantial relief of pain attacks, and headache days, respectively.

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 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

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