Occipital Nerve Stimulation Study
The Lancet 2007; 369:1099-1106
Treatment of medically intractable cluster headache by occipital nerve
stimulation: long-term follow-up of eight patients
Brian Burns MRCP a, Laurence Watkins FRCS b and Prof Peter J Goadsby MD a c
Brian Burns MRCP a, Laurence Watkins FRCS b and Prof Peter J Goadsby MD a c
Summary
Background
Cluster headache is a form of primary headache that features repeated attacks of excruciatingly severe headache usually occurring several times a day. Patients with chronic cluster headache have unremitting illness that necessitates daily preventive medical treatment for years. When medically intractable, the condition has previously been treatable only with cranially invasive or neurally destructive methods.
Background
Cluster headache is a form of primary headache that features repeated attacks of excruciatingly severe headache usually occurring several times a day. Patients with chronic cluster headache have unremitting illness that necessitates daily preventive medical treatment for years. When medically intractable, the condition has previously been treatable only with cranially invasive or neurally destructive methods.
Methods
Eight patients with medically intractable chronic cluster headache were implanted in the suboccipital region with electrodes for occipital nerve stimulation. Other than the first patient, who was initially stimulated unilaterally before being stimulated bilaterally, all patients were stimulated bilaterally during treatment.
Eight patients with medically intractable chronic cluster headache were implanted in the suboccipital region with electrodes for occipital nerve stimulation. Other than the first patient, who was initially stimulated unilaterally before being stimulated bilaterally, all patients were stimulated bilaterally during treatment.
Findings
At a median follow-up of 20 months (range 6–27 months for bilateral stimulation), six of eight patients reported responses that were sufficiently meaningful for them to recommend the treatment to similarly affected patients with chronic cluster headache. Two patients noticed a substantial improvement (90% and 95%) in their attacks; three patients noticed a moderate improvement (40%, 60%, and 20–80%) and one reported mild improvement (25%). Improvements occurred in both frequency and severity of attacks. These changes took place over weeks or months, although attacks returned in days when the device malfunctioned (eg, with battery depletion). Adverse events of concern were lead migrations in one patient and battery depletion requiring replacement in four.
At a median follow-up of 20 months (range 6–27 months for bilateral stimulation), six of eight patients reported responses that were sufficiently meaningful for them to recommend the treatment to similarly affected patients with chronic cluster headache. Two patients noticed a substantial improvement (90% and 95%) in their attacks; three patients noticed a moderate improvement (40%, 60%, and 20–80%) and one reported mild improvement (25%). Improvements occurred in both frequency and severity of attacks. These changes took place over weeks or months, although attacks returned in days when the device malfunctioned (eg, with battery depletion). Adverse events of concern were lead migrations in one patient and battery depletion requiring replacement in four.
Interpretation
Occipital nerve stimulation in cluster headache seems to offer a safe, effective treatment option that could begin a new era of neurostimulation therapy for primary headache syndromes.
Occipital nerve stimulation in cluster headache seems to offer a safe, effective treatment option that could begin a new era of neurostimulation therapy for primary headache syndromes.
Affiliations
a. Headache Group, Institute of Neurology, National Hospital for Neurology
and Neurosurgery, London WC1N 3BG, UK
b. Division of Neurosurgery, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
c. Department of Neurology, University of California, San Francisco, CA, USA
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Cen Eur Neurosurg. 2011 Mar 29.
b. Division of Neurosurgery, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
c. Department of Neurology, University of California, San Francisco, CA, USA
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Cen Eur Neurosurg. 2011 Mar 29.
Occipital Nerve Stimulation for the Treatment of Chronic Cluster Headache -
Lessons Learned from 18 Months Experience.
Mueller OM, Gaul C, Katsarava Z, Diener HC, Sure U, Gasser T.
Mueller OM, Gaul C, Katsarava Z, Diener HC, Sure U, Gasser T.
University Hospital Essen, Neurosurgery, Essen, Germany.
Abstract
OBJECTIVE: Neuromodulation has been recognized as a valuable surgical treatment option for patients with refractory chronic cluster headache (CCH). Due to the small number of afflicted individuals, the knowledge about this specific therapy is limited. In this study, we present our experiences with bilateral occipital nerve stimulation (ONS) in patients with CCH focusing on patient selection, pre- and postoperative evaluation, surgical procedures, and outcome.
OBJECTIVE: Neuromodulation has been recognized as a valuable surgical treatment option for patients with refractory chronic cluster headache (CCH). Due to the small number of afflicted individuals, the knowledge about this specific therapy is limited. In this study, we present our experiences with bilateral occipital nerve stimulation (ONS) in patients with CCH focusing on patient selection, pre- and postoperative evaluation, surgical procedures, and outcome.
PATIENTS AND METHODS: Since December 2008, 10 patients with CCH have been
treated with ONS at our department. Patients were recruited and clinically
followed by a neurologist and a neurosurgeon. Baseline data records on
frequency, intensity, and duration of attacks as well as the use of medication
were assessed with a 30-day diary. Standardized questionnaires were used pre-
and postoperatively and during the follow-up on a regular basis. Surgical
procedure and stimulation parameters were standardized for all patients. Lead
implantation was followed by a test period of 30 days prior to implantation of
the permanent generator. Mean follow-up time was 12 months (range 3-18).
RESULTS: All patients responded to the stimulation treatment. Frequency,
duration, and severity of the cluster attacks were reduced in 90% of the
patients. One patient had a significant reduction of his concomitant tension
headache. 70 % of the patients needed less medication during the attacks. All
patients reported an improvement in their quality of life. The SF-36 showed a
tendency toward objective improvement in the field of psychological comfort. As
a major adverse event, one generator had to be exchanged due to a local
infection. Another patient had to be reoperated due to a scar tissue formation
around the thoracic connector.
CONCLUSIONS: ONS is a valuable tool in the treatment of patients with
refractory CCH. According to our data, the potential side effects and
complication rates of the operation are small. With a meticulous selection of
patients by an interdisciplinary team, CCH can bed improve in the majority of
the patients. Yet, the optimal parameters for the stimulation regarding pulse
width and frequency remain unclear. For this reason, we started a prospective
single-center observational trial at our center in October 2009, including
patients with ONS, to identify the best stimulation parameters.
UPDATED April, 2011
Prog Neurol Surg. 2011;24:126-32. Epub 2011 Mar 21.
PERIPHERAL NERVE STIMULATION IN CHRONIC CLUSTER HEADACHE.
Magis D, Schoenen J.
SourceHeadache Research Unit, University Department of Neurology, CHR Citadelle, Liège, Belgium.
PERIPHERAL NERVE STIMULATION IN CHRONIC CLUSTER HEADACHE.
Magis D, Schoenen J.
SourceHeadache Research Unit, University Department of Neurology, CHR Citadelle, Liège, Belgium.
Abstract
Cluster headache is well known as one of the most painful primary neurovascular headache. Since 1% of chronic cluster headache patients become refractory to all existing pharmacological treatments, various invasive and sometimes mutilating procedures have been tempted in the last decades. Recently, neurostimulation methods have raised new hope for drug-resistant chronic cluster headache patients. The main focus of this chapter is on stimulation of the great occipital nerve, which has been the best evaluated peripheral nerve stimulation technique in drug-resistant chronic cluster headache, providing the most convincing results so far. Other peripheral nerve stimulation approaches used for this indication are also reviewed in detail. Although available studies are limited to a relatively small number of patients and placebo-controlled trials are lacking, existent clinical data suggest that occipital nerve stimulation should nonetheless be recommended for intractable chronic cluster headache patients before more invasive deep brain stimulation surgery. More studies are needed to evaluate the usefulness of supraorbital nerve stimulation and of vagus nerve stimulation in management of cluster headaches.
Cluster headache is well known as one of the most painful primary neurovascular headache. Since 1% of chronic cluster headache patients become refractory to all existing pharmacological treatments, various invasive and sometimes mutilating procedures have been tempted in the last decades. Recently, neurostimulation methods have raised new hope for drug-resistant chronic cluster headache patients. The main focus of this chapter is on stimulation of the great occipital nerve, which has been the best evaluated peripheral nerve stimulation technique in drug-resistant chronic cluster headache, providing the most convincing results so far. Other peripheral nerve stimulation approaches used for this indication are also reviewed in detail. Although available studies are limited to a relatively small number of patients and placebo-controlled trials are lacking, existent clinical data suggest that occipital nerve stimulation should nonetheless be recommended for intractable chronic cluster headache patients before more invasive deep brain stimulation surgery. More studies are needed to evaluate the usefulness of supraorbital nerve stimulation and of vagus nerve stimulation in management of cluster headaches.
Copyright © 2011 S. Karger AG, Basel.
PMID:21422783[PubMed]
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