scholarly journals EHMTI-0312. Long term efficiency and tolerability of greater occipital nerve infiltrations in primary headache disorders

2014 ◽  
Vol 15 (S1) ◽  
Author(s):  
S Lim ◽  
T Young
Keyword(s):  
Primary Headache ◽  
Headache Disorders ◽  
Occipital Nerve ◽  
Primary Headache Disorders ◽  
Greater Occipital Nerve

scholarly journals Greater Occipital Nerve Stimulation via the Bion® Microstimulator: Implantation Technique and Stimulation Parameters Clinical Trial: NCT00205894

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 621-628 ◽  
Author(s):  
Terrence L. Trentman
Keyword(s):  
Nerve Stimulation ◽  
Primary Headache ◽  
Implantation Technique ◽  
Headache Disorders ◽  
Occipital Nerve ◽  
Primary Headache Disorders ◽  
Stimulation Parameters ◽  
Greater Occipital Nerve ◽  
The Mean ◽  
One Year

Background: Millions of patients suffer from medically refractory and disabling primary headache disorders. This problem has led to a search for new and innovative treatment modalities, including neuromodulation of the occipital nerves. Objectives: The primary aim of this study is to describe an implantation technique for the Bion® microstimulator and document stimulation parameters and stimulation maps after Bion placement adjacent to the greater occipital nerve. The secondary aim is to document outcome measures one year post-implant. Design: Prospective, observational feasibility study. Methods: Nine patients with medically refractory primary headache disorders participated in this study. Approximately 6 months after Bion insertion, stimulation parameters and maps were documented for all patients. At one year, outcome measures were collected including the Migraine Disability Assessment Score. Results: At 6 months, the mean perception threshold was 0.47 mA, while the mean discomfort threshold was 6.8 mA (stimulation range 0.47 – 6.8 mA). The mean paresthesia threshold was 1.64 mA and the mean usage range was 16.0. There were no major complications reported such as device migration, infection, or erosion. One patient stopped using her Bion before the 12-month follow-up visit. At one year, 7 of the 8 patients were judged as having obtained fair or better results in terms of reduction of disability; 5 patients had greater than a 90% reduction in disability. Limitations: Small, heterogeneous patient population without control group. Not blinded or randomized. Conclusion: The Bion can be successfully inserted adjacent to the greater occipital nerve in an effort to treat refractory primary headache disorders. This microstimulator may provide effective occipital stimulation and headache control while minimizing the risks associated with percutaneous or paddle leads implanted subcutaneously in the occipital region. Key words: Chronic headache, migraine, cluster headache, peripheral nerve stimulation

Long-Term Outcome in Occipital Nerve Stimulation Patients With Medically Intractable Primary Headache Disorders

2012 ◽  
Vol 16 (6) ◽  
pp. 557-564 ◽  
Author(s):  
Ann Chang Brewer ◽  
Terrence L. Trentman ◽  
Michael G. Ivancic ◽  
Bert B. Vargas ◽  
Alanna M. Rebecca ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Primary Headache ◽  
Headache Disorders ◽  
Occipital Nerve Stimulation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Occipital Nerve ◽  
Primary Headache Disorders

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.

Functional Connectivity between Trigeminal and Occipital Nerves Revealed by Occipital Nerve Blockade and Nociceptive Blink Reflexes

Cephalalgia ◽  
2006 ◽  
Vol 26 (1) ◽  
pp. 50-55 ◽  
Author(s):  
V Busch ◽  
W Jakob ◽  
T Juergens ◽  
W Schulte-Mattler ◽  
H Kaube ◽  
...  
Keyword(s):  
Pain Perception ◽  
Primary Headache ◽  
Repeated Measurements ◽  
Afferent Pathways ◽  
Nerve Blockade ◽  
Occipital Nerve ◽  
Primary Headache Disorders ◽  
Nociceptive Blink Reflex ◽  
Greater Occipital Nerve ◽  
Neurophysiological Studies

Headache syndromes often suggest occipital and neck involvement, although it is still unknown to what extent branches of segment C1-C3 contribute actively to primary headache. Pain within the occipital area may be referred to the trigeminal territory. However, a modulation of trigeminal transmission by affecting cervical input in humans has not been elucidated so far. A convergence of cervical and trigeminal input at the level of the caudal part of the trigeminal nucleus in the brainstem has been suggested due to anatomical and neurophysiological studies in animals. We examined the R2 components of the nociceptive blink reflex responses in 15 healthy subjects before and after unilateral nerve blockade of the greater occipital nerve with 5 ml prilocain (1%). R2 response areas (AUC) decreased and the R2 latencies increased significantly after the nerve blockade only on the side of injection. AUC and latencies on the non-injection side remained stable. Thresholds for sensory or pain perception did not differ significantly between the repeated measurements on both sides. Our findings extend previous results related to anatomical and functional convergence of trigeminal and cervical afferent pathways in animals and suggest that the modulation of this pathway is of potential benefit in primary headache disorders.

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.

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