TM2-5 Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study

2019 ◽  
Vol 90 (3) ◽  
pp. e14.1-e14
Author(s):  
MW Weatherall ◽  
D Nandi
Keyword(s):  
Cluster Headache ◽  
Treatment Options ◽  
Primary Headache ◽  
Cervicogenic Headache ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Single Shot ◽  
Headache Disorders ◽  
Trigeminal Neuropathy ◽  
Primary Headache Disorders

ObjectivesPrimary headache disorders are common, but many patients are refractory to medical treatment. PENS therapy involves the stimulation of one or more individual nerves or dermatomes using needle probes. We assessed whether a ‘single shot with single probe’ strategy would benefit patients with refractory headache disorders, including chronic migraine (CM), and chronic cluster headache (CCH).DesignService evaluation of 36 patients treated with PENS therapy between September 2012 and June 2016. Follow-up data was available for 33 patients.Subjects16 patients with CM, nine with CCH, and one with hemicrania continua. Secondary headaches comprised occipital neuralgia, cervicogenic headache, and trigeminal neuropathy.MethodsPENS was given using Algotec® disposable 21 gauge PENS therapy probes (8 cm) to the occipital nerve ipsilateral to the pain (or bilaterally in cases of bilateral pain). Stimulation was delivered at 2 Hz/100 Hz, at 3 cycles/second, between 1.2–2.5 V depending on patient tolerability, for 25–28 min.Results6/9 patients with CCH improved significantly after the first session. In all patients with CCH, PENS therapy was well tolerated, with no significant adverse events reported. One patient with CCH reverted to episodic cluster. Only four patients with CM experienced any benefit.ConclusionsPENS therapy shows potential as a relatively non-invasive, low-risk, and inexpensive component of the treatment options for refractory primary headache disorders, particularly chronic cluster headache.

Neuromodulatory Approaches to the Management of Medically Refractory Cluster Headache

2010 ◽  
Vol 5 (1) ◽  
pp. 97
Author(s):  
Arne May ◽  
Peter J Goadsby ◽  
◽  
Keyword(s):  
Cluster Headache ◽  
Treatment Options ◽  
Primary Headache ◽  
Chronic Cluster Headache ◽  
Primary Headache Disorders ◽  
Greater Occipital Nerve ◽  
Term Data ◽  
Deep Brain ◽  
Stimulation Of

The trigeminal autonomic cephalalgias are a group of primary headache disorders characterised by unilateral trigeminal distribution of pain that occurs in association with ipsilateral cranial autonomic features. The most prominent one is cluster headache, a dreadful disease with excrutiating pain attacks. These attacks last no longer than two hours but may occur several times per day. It is mandatory to find an efficient therapy for these patients, but some are unresponsive to all treatments. In these intractable cases invasive procedures are introduced, but the available evidence (while conflicting) illustrates that trigeminal denervation may not be effective in preventing the headache attacks or autonomic symptoms of chronic cluster headache. Modern neurostimulating approaches, such as stimulation of the greater occipital nerve and hypothalamic deep brain stimulation, supersede neurodestructive procedures. Both stimulation methods are exquisite and potentially lifesaving treatment options in otherwise intractable patients, but they need to be better characterised and further long-term data are needed.

Neuromodulatory Approaches to the Management of Medically Refractory Cluster Headache

US Neurology ◽  
2010 ◽  
Vol 06 (02) ◽  
pp. 125
Author(s):  
Arne May ◽  
Peter J Goadsby ◽  
◽  
Keyword(s):  
Cluster Headache ◽  
Treatment Options ◽  
Primary Headache ◽  
Chronic Cluster Headache ◽  
Primary Headache Disorders ◽  
Life Saving ◽  
Greater Occipital Nerve ◽  
Term Data ◽  
Deep Brain

The trigeminal autonomic cephalalgias are a group of primary headache disorders characterized by unilateral trigeminal distribution of pain that occurs in association with ipsilateral cranial autonomic features. The most prominent one is cluster headache, a dreadful disease with excrutiating pain attacks. These attacks last no longer than two hours but may occur several times per day. It is mandatory to find an efficient therapy for these patients, but some are unresponsive to all treatments. In these intractable cases invasive procedures are introduced, but the available evidence (while conflicting) illustrates that trigeminal denervation may not be effective in preventing the headache attacks or autonomic symptoms of chronic cluster headache. Modern neurostimulating approaches, such as stimulation of the greater occipital nerve and hypothalamic deep brain stimulation, supersede neurodestructive procedures. Both stimulation methods are exquisite and potentially life-saving treatment options in otherwise intractable patients, but they need to be better characterized and further long-term data are needed.

Concomitant occurrence of different trigeminal autonomic cephalalgias: A case series and review of the literature

Cephalalgia ◽  
2013 ◽  
Vol 34 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Andreas Totzeck ◽  
Hans-Christoph Diener ◽  
Charly Gaul
Keyword(s):  
Cluster Headache ◽  
Clinical Presentation ◽  
Case Series ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Trigeminal Autonomic Cephalalgias ◽  
Headache Disorders ◽  
Primary Headache Disorders

Introduction The trigeminal autonomic cephalalgias (TACs) subsume four primary headache disorders. Hemicrania continua is increasingly regarded as an additional TAC. In rare cases patients may present with two different TACs or a TAC and hemicrania continua. Cases We report four patients with two different TACs or one TAC and hemicrania continua. Two patients presented with cluster headache and paroxysmal hemicrania, one patient with cluster headache and hemicrania continua, and one patient suffered from cluster headache and SUNCT. Discussion While the International Classification of Headache Disorders (ICHD-II) proposes specific diagnostic criteria, the variability of clinical presentation may make clear diagnosis difficult. All patients fulfilled the ICHD-II criteria. The manifestation of two different TACs or hemicrania continua in one patient is uncommon but possible and should be taken into account especially when chronic headache patients present with changing headache symptoms.

Continuous Sphenopalatine Ganglion Block for Refractory Hemicrania Continua

2021 ◽  
Author(s):  
Carlos E Restrepo-Garces
Keyword(s):  
Primary Headache ◽  
Hemicrania Continua ◽  
Trigeminal Autonomic Cephalalgias ◽  
Sphenopalatine Ganglion ◽  
Headache Disorders ◽  
Ganglion Block ◽  
Pharmacological Management ◽  
Primary Headache Disorders ◽  
Significant Challenge ◽  
Sphenopalatine Ganglion Block

Trigeminal autonomic cephalalgias (TAC) pose a significant challenge for pain physicians. Despite being part of the primary headache disorders, they are uncommon in the general population. Although the literature commonly describes pharmacological management, in refractory patients, interventional pain modalities may be necessary .

Cluster Headache and Other Trigeminal Autonomic Cephalalgias

2018 ◽  
Vol 38 (06) ◽  
pp. 603-607
Author(s):  
Brian McGeeney
Keyword(s):  
Cluster Headache ◽  
Health Care Providers ◽  
Treatment Options ◽  
Primary Headache ◽  
Trigeminal Autonomic Cephalalgias ◽  
Care Providers ◽  
Private Industry ◽  
Primary Headache Disorders ◽  
New Treatments ◽  
Delays In Diagnosis

AbstractThe trigeminal autonomic cephalalgias are a group of distinct primary headache disorders that share common characteristics of strict unilateral headache often accompanied by unilateral cranial autonomic features. Cluster headache is the most well-known example, but other than neurologists, practitioners often have limited familiarity with these disorders and treatment options. Delays in diagnosis are typical and treatment options remain suboptimal, associated with limited scientific research into these brain disorders. Improved familiarity with core clinical features by health care providers should lead to earlier referral to specialists, and this education is the responsibility of headache medicine specialists. Optimistically, the last few years have seen lobbying for more federal research support in headache medicine and there has been renewed interest by private industry in potential new treatments for trigeminal autonomic cephalalgias.

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.

Markers of endothelial function in migraine patients: Results from a bi-center prospective study

Cephalalgia ◽  
2014 ◽  
Vol 35 (10) ◽  
pp. 877-885 ◽  
Author(s):  
Marlene Fischer ◽  
Charly Gaul ◽  
Hind Shanib ◽  
Dagny Holle ◽  
Lorin Loacker ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Cluster Headache ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Healthy Controls ◽  
Headache Disorders ◽  
Endothelial Markers ◽  
Primary Headache Disorders ◽  
Significant Difference ◽  
Type Headache

Background Numerous studies suggest an increased vascular risk in patients with migraine, in particular in those with aura. A possible link between both conditions might be a dysfunction of the vascular endothelium. This observational study analyzed the endothelial markers angiopoietin-1, angiopoietin-2, Tie-2, sFlt-1 and NT-proBNP for the first time in migraineurs, patients with other primary headache disorders and healthy controls. Methods Patients with episodic migraine with and without aura, episodic cluster headache, tension-type headache and healthy controls were included. Blood samples were obtained during migraine attacks and headache-free periods in migraineurs, in and out of bout in cluster headache and during headache-free periods in tension-type headache and healthy individuals to analyze markers of endothelial function. Results No significant difference in endothelial markers between migraine, other headache disorders and healthy controls was detected. There was no significant difference between migraine attacks and headache-free intervals. Additionally, no distinction could be found between migraine with and without aura. Discussion The endothelial markers analyzed do not display a characteristic pattern in different headache disorders especially migraine compared to healthy controls. The novel findings of our study indicate that factors other than endothelial dysfunction seem to be responsible for the at least statistical association of migraine with vascular disease.

scholarly journals Cluster Headache and the Comprehension Paradox

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Heiko Pohl ◽  
Andreas R. Gantenbein ◽  
Peter S. Sandor ◽  
Jean Schoenen ◽  
Colette Andrée
Keyword(s):  
Sick Leave ◽  
Cluster Headache ◽  
Leisure Activities ◽  
Primary Headache ◽  
Headache Disorders ◽  
Online Questionnaire ◽  
Primary Headache Disorders ◽  
The Times ◽  
Headache Patients

AbstractPatients with primary headache disorders such as cluster headache cycle between being entirely healthy and almost completely incapacitated. Sick leave or reduced performance due to headache attacks demands flexibility by their social counterparts. The objective of this study is to test the hypothesis that headache patients cause frustration that grows with the times colleagues have to take over their work. In this study, we analysed cluster headache patients’ answers to an online questionnaire. Participants self-reported their number of sick days, the number of days on which leisure activities were missed and whether they felt understood by colleagues and family. We then investigated the correlation between the number of sick days and the proportion of patients feeling understood by colleagues and friends. We found that feeling understood by colleagues and friends decreases with a growing number of sick days. However, when sick days accrue further, this proportion increases again. The number of sick days correlates similarly with both colleagues’ and friends’ understanding. The number of cluster headache patients feeling understood by others decreases with an increasing number of sick days. Their social circles’ frustration with the patients’ failure to meet obligations and expectations are a likely reason. With a growing number of sick days, however, the portion of patients feeling understood rises again despite patients meeting others’ expectations even less. This ‘comprehension paradox’ implies the influence of other factors. We suspect that growing numbers of sick days foster understanding as the disability of the disease becomes increasingly apparent.

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