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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Occipital 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The 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).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>ONS 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.</jats:p></jats:sec>

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

“…The decline in this parameter improved progressively at the 3rd and 6th month and the greatest reductions were registered one year after ONS surgery, of 7.5 attacks per week, which reached 15 at the end of follow-up. The fact that ONS effectivity appears to slightly decrease over time was also reported by Aibar Duran et al [19], but, in their study, the decrease in effectiveness was seen at month 6, and, in our study, it was found later. Despite this fact, our results are hopeful considering that this means a 50% reduction in attacks at the end of follow-up.…”

“…Although the ONS is not an economic treatment [25], the direct and indirect cost generated by the usually young patients diagnosed with drCCH widely exceeds the cost of this therapy [26]. Adverse events in our series were much lower than those described in previous cohorts [9,15,17,19,27]. ONS seems to be a safe technique when implants are conducted in highly specialised centers for those CH patients who have failed several preventive treatments, and we think it should be offered as the first option to drCCH patients.…”

Effect of Occipital Nerve Stimulation (ONS) on the Orbicularis Oculi Reflex Triggered by a Standardized Air Flow in Patients with Chronic Migraine—A Prospective, Randomized, Interventional Study

“…An increased afferent input to the trigeminocervical complex (TCC) with increased peripheral sensitization and a generalized central sensitization of the trigeminospinal or the second order trigeminal neurons can contribute to the development of chronic headache. In addition, a disruption of the descending pain inhibitory pathway can lead to increased sensitization and be relevant in the chronification of headache [1,2,4,17,33,36]. Increased activity in the descending pain pathway in ONS was also shown in a positron emission tomography (PET) study [1].…”

An unusual case of lead migration in occipital nerve stimulation: A case report and literature review

“…It is hard to properly assess the incidence of lead migration in ONS since the studies that report it are heterogeneous, describe few cases, and present extremely variable results [ Table 1 ]. [ 2 , 3 , 7 , 11 , 14 , 15 , 17 - 22 , 24 , 28 - 30 , 32 , 34 , 41 ] In our review, we identified five randomized clinical trials which reported lead migration. [ 1 , 8 , 23 , 31 , 33 ] These trials have reported a migration incidence that ranges from 12.9% to 50.9%.…”