Simultaneous Sphenopalatine and Occipital Nerve Stimulation in Treatment of Chronic Refractory Cluster Headache: A Case Report

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.

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Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.447 ◽

2019 ◽

Vol 5 (22;5) ◽

pp. 447-477

Author(s):

Ajay Antony

Keyword(s):

Peripheral Nerve ◽

Cluster Headache ◽

Nerve Stimulation ◽

Facial Pain ◽

Current Evidence ◽

Occipital Neuralgia ◽

Occipital Nerve Stimulation ◽

Peripheral Nerve Stimulator ◽

Occipital Nerve ◽

Craniofacial Pain

Background: Head and facial pain is a common and often difficult to treat disorder. Routine treatments sometimes fail to provide acceptable relief, leaving the patient searching for something else, including narcotics and surgery. Recently, neuromodulation has been expanding to provide another option. Secondary to its potentially temporary nature and relatively manageable risk profile, several reviews have suggested trialing neuromodulation prior to starting narcotics or invasive permanent surgeries. There is evidence that neuromodulation can make a difference in those patients with intractable severe craniofacial pain. Objectives: To provide a basic overview of the anatomy, epidemiology, pathophysiology and common treatments of several common head and facial disorders. Furthermore, to demonstrate the suggested mechanisms of neuromodulation and the evidence currently existing for the use of neuromodulation. Methods: A comprehensive review was performed regarding the available literature through targeting articles reporting on the use of neuromodulation to treat pain of the head and face. Results: We compiled and discuss the current evidence available in treating head and facial pain. The strongest evidence currently for neuromodulation is for occipital nerve stimulation for migraine, transcutaneous vagal nerve stimulation for migraine and cluster headache, sphenopalatine ganglion microstimulation for cluster headache, and transcutaneous supraorbital and supratrochlear nerve stimulation for migraine. In addition, there is moderate evidence for occipital nerve stimulation in treating occipital neuralgia. Limitations: Neuromodulation has been trialed and is promising in several craniofacial pain disorders; however, there remains a need for large-scale, randomized, placebo-controlled clinical trials to further evaluate the efficacy and safety of most treatments. Much of the current data relies on case reports without randomization or placebo controls. Conclusions: With advancing techniques and technology, neuromodulation can be promising in treating intractable pain of the head and face. Although more randomized controlled trials are warranted, the current literature supports the use of neuromodulation in intractable craniofacial pain. Key words: Neuromodulation, headache, facial pain, craniofacial pain, migraine, cluster headache, trigeminal neuralgia, occipital neuralgia, peripheral nerve stimulator, high cervical spinal cord stimulator, peripheral nerve field stimulator

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Occipital nerve stimulation and deep brain stimulation for refractory cluster headache: a prospective analysis of efficacy over time

Journal of Neurosurgery ◽

10.3171/2019.11.jns192042 ◽

2020 ◽

pp. 1-8

Author(s):

Juan Ángel Aibar-Durán ◽

María Jesús Álvarez Holzapfel ◽

Rodrigo Rodríguez Rodríguez ◽

Robert Belvis Nieto ◽

Carles Roig Arnall ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Clinical Response ◽

Brain Stimulation ◽

Nerve Stimulation ◽

Occipital Nerve Stimulation ◽

Occipital Nerve ◽

Over Time ◽

Deep Brain

OBJECTIVEOccipital nerve stimulation (ONS) and deep brain stimulation (DBS) are widely used surgical treatments for chronic refractory cluster headache (CH). However, there is little literature regarding long-term follow-up of these treatments.METHODSThe authors describe two prospective cohorts of patients with refractory CH treated with ONS and DBS and compare preoperative to postoperative status at 6 and 12 months after the surgery and at final follow-up. Efficacy analysis using objective and subjective variables is reported, as well as medication reduction and complications.RESULTSThe ONS group consisted of 13 men and 4 women, with a median age of 44 years (range 31–61 years). The median number of attacks per week (NAw) before surgery was 28 (range 7–70), and the median follow-up duration was 48 months. The DBS group comprised 5 men and 2 women, with a median age of 50 years (range 29–64 years). The median NAw before surgery was 56 (range 14–140), and the median follow-up was 36 months. The NAw and visual analog scale score were significantly reduced for the ONS and DBS groups after surgery. However, while all the patients from the DBS group were considered responders at final follow-up, with more than 85% being satisfied with the treatment, approximately 29% of initial responders to ONS became resistant by the final follow-up (p = 0.0253).CONCLUSIONSONS is initially effective as a treatment for refractory CH, although a trend toward loss of efficacy was observed. No clear predictors of good clinical response were found in the present study. Conversely, DBS appears to be effective and provide a more stable clinical response over time with an acceptable rate of surgical complications.

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