Occipital nerve stimulation improves the quality of life in medically-intractable chronic cluster headache: Results of an observational prospective study

Abstract

Background Occipital nerve stimulation (ONS) has been proposed to treat chronic medically-intractable cluster headache (iCCH) in small series of cases without evaluation of its functional and emotional impacts. Methods We report the multidimensional outcome of a large observational study of iCCH patients, treated by ONS within a nationwide multidisciplinary network ( https://clinicaltrials.gov NCT01842763), with a one-year follow-up. Prospective evaluation was performed before surgery, then three and 12 months after. Results One year after ONS, the attack frequency per week was decreased >30% in 64% and >50% in 59% of the 44 patients. Mean (Standard Deviation) weekly attack frequency decreased from 21.5 (16.3) to 10.7 (13.8) ( p = 0.0002). About 70% of the patients responded to ONS, 47.8% being excellent responders. Prophylactic treatments could be decreased in 40% of patients. Functional (HIT-6 and MIDAS scales) and emotional (HAD scale) impacts were significantly improved, as well as the health-related quality of life (EQ-5D). The mean (SD) EQ-5D visual analogic scale score increased from 35.2 (23.6) to 51.9 (25.7) ( p = 0.0037). Surgical minor complications were observed in 33% of the patients. Conclusion ONS significantly reduced the attack frequency per week, as well as the functional and emotional headache impacts in iCCH patients, and dramatically improved the health-related quality of life of responders.

Burst Occipital Nerve Stimulation for Chronic Migraine and Chronic Cluster Headache

“…Some studies have also reported a reduction in the intensity of residual headaches; figures range widely, from no reduction at all, up to a 50% improvement. In the larger series, there were reductions in attack intensity of some 25% . All the 5 patients presented here experienced a reduction of 80% or more in attack frequency, with a mean reduction of 92%.…”

“…In three large series of tONS for CCH, attack frequencies were reduced by 46–58% . The response in migraine is relatively modest, with a reduction of less than three headache days per month when the control response is subtracted .…”

Neurostimulation for the treatment of chronic migraine and cluster headache

“…32 Another retrospective study, showed after a median follow-up of 17.5 months, that out of 14 CCH, three noticed a significant improvement (90%-95%), another three a moderate improvement (40%-60%), and 4 noticed a mild improvement (20%-30%). 32 Another retrospective study, showed after a median follow-up of 17.5 months, that out of 14 CCH, three noticed a significant improvement (90%-95%), another three a moderate improvement (40%-60%), and 4 noticed a mild improvement (20%-30%).…”

Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache

“…Other modalities may potentially be reported in future randomized trials. Implanted occipital nerve stimulation has been studied for cluster headache in nonrandomized studies with the suggestion of efficacy and safety . A prospective, multicenter, randomized control trial is underway in Europe to treat cluster headache using this technology .…”

“…Implanted occipital nerve stimulation has been studied for cluster headache in nonrandomized studies with the suggestion of efficacy and safety. [45][46][47][48][49][50] A prospective, multicenter, randomized control trial is underway in Europe to treat cluster headache using this technology. 51,52 A small study of 7 patients with chronic cluster headache also demonstrated efficacy and safety for high cervical cord stimulation but no data from any randomized trials are available.…”