Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients

Abstract

Intractable chronic cluster headache (CCH) is a devastating, disabling condition that has traditionally been treated with cranially invasive or neurally destructive procedures. ONS offers a safe, effective option for some patients with CCH. More work is required to evaluate and understand this novel therapy.

Occipital Nerve Stimulation for Headache Disorders

“…13 In the chronic cluster headache, which is a devastating condition, results have been variable, and in the two largest case series (one prospective and one retrospective), at least 50% improvement was noted in approximately one third and two thirds of patients, respectively. 16,17 In the prospective study, a delay of 2 months or more between implantation and significant clinical improvement was noted, which suggests that ONS acts via slow neuromodulatory processes in chronic cluster headaches. 17 It seems reasonable to propose a trial of ONS in patients with drug-resistant chronic cluster headaches before considering hypothalamic deep-brain stimulation.…”

“…In the past few years, the application of ONS has been widened to include a large number of primary and secondary headache disorders, such as migraine, chronic cluster headache, new daily persistent headache, hemicrania continua, chronic post-traumatic headache, chronic headache attributed to whiplash injury, cervicogenic headache, and occipital neuropathy. [13][14][15][16][17][18][19] Identification of specific headache diagnoses that respond to ONS remains a challenge. 13 Recently, ONS has been evaluated in clinical trials in migraine and chronic cluster headaches.…”

Surgical Interventions for Cluster Headache, Including Implanted Stimulators

“…Many authors advocate the use of ONS prior to hypothalamic DBS when considering a neuromodulation procedure (Ambrosini 2007;Leone et al 2008;Bartsch et al 2009;Burns et al 2009). Criteria have been proposed to select chronic CH patients that are suitable candidates for DBS ).…”

“…The technique is however far from standardized as many technical variations have been described (Paemeleire and Bartsch 2010). In chronic CH results have been variable, as at least 50% improvement was noted in about 1/3 and 2/3 of patients respectively in the two largest case series, one prospective on 8 patients and one retrospective on 14 patients (Magis et al 2007;Burns et al 2009). The delay to clinical efficacy is variable and in the prospective study, a delay of 2 months or more between implantation and significant clinical improvement was noted, which suggests that ONS acts via slow neuromodulatory processes in chronic CH and argues against a 1 month trial period that is often part of the procedure and may be required for reimboursement (Magis et al 2007).…”

“…However, there is a consistent need for frequent reinterventions (including for battery replacement and lead migration) and some unpleasant local side effects may arise (including discomfort, shock like sensation, neck stiffness, muscle spasm and lead tip erosion). Some have opted for immediate bilateral ONS implantation after reports of contralateral development of cluster attacks in patients who described side locked attacks before implantation (Burns et al 2009). …”