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

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.

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.

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.

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.

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

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.

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.

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