scholarly journals Occipital Nerve Stimulation for Pain Modulation in Drug-Resistant Chronic Cluster Headache

2021 ◽  
Vol 11 (2) ◽  
pp. 236
Author(s):  
Javier Díaz-de-Terán ◽  
Javier A. Membrilla ◽  
José Paz-Solís ◽  
Iñigo de Lorenzo ◽  
Javier Roa ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cluster Headache ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Oral Medication ◽  
Drug Resistant ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve

Occipital nerve stimulation (ONS) is a surgical treatment proposed for drug-resistant chronic cluster headache (drCCH). Long-term series assessing its efficacy are scarce. We designed a retrospective observational study with consecutive sampling, evaluating the follow-up of 17 drCCH patients who underwent ONS. Our main endpoint was the reduction the rate of attacks per week. We also evaluated the pain intensity through the Visual Analogue Scale (VAS), patient overall perceived improvement and decrease in oral medication intake. After a median follow-up of 6.0 years (4.5–9.0), patients decreased from a median of 30 weekly attacks to 22.5 (5.6–37.5, p = 0.012), 7.5 at 1 year (p = 0.006) and 15.0 at the end of follow-up (p = 0.041). The VAS decreased from a median of 10.0 to 8.0 (p = 0.011) at three months, to 7.0 (p = 0.008) at twelve months and 7.0 (p = 0.003) at the end of the follow-up. A total of 23.5% had an overall perceived improvement of ≥70% at 3 months, 41.2% at 1 year and 27.8% at the end of follow-up. Reducing prophylactic oral medication was possible in 76.5% and it was stopped in 17.7%. Triptan use decreased in all the responder patients and 17.7% stopped its intake. A total of 41.2% presented mild adverse events. In conclusion, our long-term experience suggests that ONS could be an interesting option for drCCH-selected patients, as it is a beneficial and minimally invasive procedure with no serious adverse events.

Long-term occipital nerve stimulation for drug-resistant chronic cluster headache

Cephalalgia ◽  
2016 ◽  
Vol 37 (8) ◽  
pp. 756-763 ◽  
Author(s):  
Massimo Leone ◽  
Alberto Proietti Cecchini ◽  
Giuseppe Messina ◽  
Angelo Franzini
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Stable Condition ◽  
Chronic Cluster Headache ◽  
Drug Resistant ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Headache Patients

Introduction Chronic cluster headache is rare and some of these patients become drug-resistant. Occipital nerve stimulation has been successfully employed in open studies to treat chronic drug-resistant cluster headache. Data from large group of occipital nerve stimulation-treated chronic cluster headache patients with long duration follow-up are advantageous. Patients and methods Efficacy of occipital nerve stimulation has been evaluated in an experimental monocentric open-label study including 35 chronic drug-resistant cluster headache patients (mean age 42 years; 30 men; mean illness duration: 6.7 years). The primary end-point was a reduction in number of daily attacks. Results After a median follow-up of 6.1 years (range 1.6–10.7), 20 (66.7%) patients were responders (≥50% reduction in headache number per day): 12 (40%) responders showed a stable condition characterized by sporadic attacks, five responders had a 60–80% reduction in headache number per day and in the remaining three responders chronic cluster headache was transformed in episodic cluster headache. Ten (33.3%) patients were non-responders; half of these have been responders for a long period (mean 14.6 months; range 2–48 months). Battery depletion (21 patients 70%) and electrode migration (six patients – 20%) were the most frequent adverse events. Conclusions Occipital nerve stimulation efficacy is confirmed in chronic drug-resistant cluster headaches even after an exceptional long-term follow-up. Tolerance can occur years after improvement.

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 Occipital Nerve Stimulation with the Bion® Microstimulator for the Treatment of Medically Refractory Chronic Cluster Headache

2011 ◽  
Vol 5;14 (5;9) ◽  
pp. 435-440
Author(s):  
Terrence L. Trentman
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Chart Review ◽  
Chronic Cluster Headache ◽  
Headache Frequency ◽  
Occipital Nerve Stimulation ◽  
Long Term Outcome ◽  
Occipital Nerve ◽  
Small Patient Population

Background: Chronic cluster headache is a severely disabling neurological disorder. Evidence from open-label case series suggest that occipital nerve stimulation may be effective for the treatment of chronic cluster headache. Objective: To evaluate the effectiveness of a microstimulator for chronic cluster headache. Study Design: Prospective, observational feasibility study plus medical record review. Settings: Academic medical center. Methods: Four patients with medically refractory chronic cluster headache underwent implantation of a unilateral bion microstimulator. In-person follow-up was conducted for 12 months after implantation, and a prospective follow-up chart review was carried out to assess long term outcome. Results: Three of the participants returned their headache diaries for evaluation. The mean duration of chronic cluster headache was 14.3 years (range 3 to 29 years). Pain was predominantly or exclusively retroocular/periocular. One participant demonstrated a positive response (> 50% reduction in cluster headache frequency) at 3 months postimplant, while there were 2 responders at 6 months. At least one of the participants continued to show > 60% reduction in headache frequency at 12 months. A chart review showed that at 58-67 months post-implant, all 3 participants reported continued use and benefit from stimulation. No side-shift in attacks was noted in any participant. Adverse events were limited to 2 participants with neck pain and/or cramping with stimulation at high amplitudes; one required revision for a faulty battery. Limitations: Small patient population without control group. Not blinded or randomized. Conclusion: Unilateral occipital nerve stimulation, using a minimally invasive microstimulator, may be effective for the treatment of medically refractory chronic cluster headache. This benefit may occur immediately after implantation, remain sustained up to 5 years after implantation, and occur despite the anterior location of the pain. Prospective, randomized controlled trials of occipital nerve stimulation in chronic cluster headache should proceed. Key words: chronic headache, bion, peripheral nerve stimulation, cluster headache, migraine, occipital

Long-Term Efficacy of Occipital Nerve Stimulation for Medically Intractable Cluster Headache

Neurosurgery ◽  
2020 ◽  
Author(s):  
Aurélie Leplus ◽  
Denys Fontaine ◽  
Anne Donnet ◽  
Jean Regis ◽  
Christian Lucas ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Attack Frequency ◽  
Occipital Nerve ◽  
Term Efficacy ◽  
Additional Surgery ◽  
Over Time

ABSTRACT BACKGROUND Occipital nerve stimulation (ONS) has been proposed to treat refractory chronic cluster headache (rCCH) but its efficacy has only been showed in small short-term series. OBJECTIVE To evaluate ONS long-term efficacy in rCCH. METHODS We studied 105 patients with rCCH, treated by ONS within a multicenter ONS prospective registry. Efficacy was evaluated by frequency, intensity of pain attacks, quality of life (QoL) EuroQol 5 dimensions (EQ5D), functional (Headache Impact Test-6, Migraine Disability Assessment) and emotional (Hospital Anxiety Depression Scale [HAD]) impacts, and medication consumption. RESULTS At last follow-up (mean 43.8 mo), attack frequency was reduced >50% in 69% of the patients. Mean weekly attack frequency decreased from 22.5 at baseline to 9.9 (P < .001) after ONS. Preventive and abortive medications were significantly decreased. Functional impact, anxiety, and QoL significantly improved after ONS. In excellent responders (59% of the patients), attack frequency decreased by 80% and QoL (EQ5D visual analog scale) dramatically improved from 37.8/100 to 73.2/100. When comparing baseline and 1-yr and last follow-up outcomes, efficacy was sustained over time. In multivariable analysis, low preoperative HAD-depression score was correlated to a higher risk of ONS failure. During the follow-up, 67 patients experienced at least one complication, 29 requiring an additional surgery: infection (6%), lead migration (12%) or fracture (4.5%), hardware dysfunction (8.2%), and local pain (20%). CONCLUSION Our results showed that long-term efficacy of ONS in CCH was maintained over time. In responders, ONS induced a major reduction of functional and emotional headache-related impacts and a dramatic improvement of QoL. These results obtained in real-life conditions support its use and dissemination in rCCH patients.

Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study

2007 ◽  
Vol 6 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Delphine Magis ◽  
Marta Allena ◽  
Monica Bolla ◽  
Victor De Pasqua ◽  
Jean-Michel Remacle ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cluster Headache ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Drug Resistant ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Prospective Pilot Study
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