Treatment of intractable hemicrania continua by occipital nerve stimulation

Miller, Sarah; Watkins, Laurence; Matharu, Manjit

doi:10.1136/jnnp-2017-315747

Cited by 16 publications

(8 citation statements)

References 5 publications

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“…In a series of 16 patients with implanted bilateral ONS, a mean monthly reduction in moderate-to-severe headache by 48.9% was observed [101]. ONS has also been found to be effective in 2/2 [102], 6/6 [103], and 2/4 patients [54] in case series and open-label studies.…”

Section: Occipital Nerve Stimulationmentioning

confidence: 93%

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Stubberud

Tronvik

Matharu

2020

Curr Treat Options Neurol

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Purpose of Review This review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings. Recent Findings The majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses reveal that lamotrigine for SUNHA and indomethacin for PH and HC are the preventative treatments of choice. Second-line choices include topiramate, gabapentin, and carbamazepine for SUNHA; verapamil for PH; and cyclooxygenase-2 inhibitors and gabapentin for HC. Parenteral lidocaine is highly effective as a transitional treatment for SUNHA. Novel therapeutic strategies such as non-invasive neurostimulation, targeted nerve and ganglion blockades, and invasive neurostimulation, including implanted occipital nerve stimulators and deep brain stimulation, appears to be promising options. Summary At present, lamotrigine as a prophylactic and parenteral lidocaine as transitional treatment remain the therapies of choice for SUNHA. While, by definition, both PH and CH respond exquisitely to indomethacin, evidence for other prophylactics is less convincing. Evidence for the novel emerging therapies is limited, though promising.

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Section: Occipital Nerve Stimulationmentioning

confidence: 93%

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Stubberud

Tronvik

Matharu

2020

Curr Treat Options Neurol

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“…Hemicrania continua (HC), either remitting or unremitting subtypes, is a persistent, strictly unilateral pain, associated with ipsilateral autonomic features and/or with restlessness or agitation. HC responds exclusively to indomethacin [5,144]. 5.1.…”

Section: Tacs Other Than Chmentioning

confidence: 99%

“…Half of the patients (8 out of 16) exhibited high (>50%) response rates (yielding a mean 48.9% reduction in monthly headache days) to bilateral ONS treatment. It is mentionable that the use of indomethacin dramatically (65.1%) decreased in those HC patients who continued to take the drug [144] (Table 2(a)). Another small-subject-number (n = 7 SUNCT and SUNA patients) study reported ONS to be highly effective and demonstrated a favorable safety profile [149].…”

Section: Open-label Studies Of Ons In Tacs Other Than Chmentioning

confidence: 99%

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

Tajti

Delia

Nyári

et al. 2019

Expert Review of Neurotherapeutics

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Introduction: Acute and preventive treatment of primary headache disorders is not completely resolved with regard to efficacy, safety, and tolerability. Hence, peripheral and central neuromodulation can provide therapeutic alternatives in drug-resistant cases. Peripheral targets of neuromodulation include invasive and non-invasive neurostimulation and electrical and chemical nerve and ganglion blockades. Areas covered: A PubMed search of papers published from January 2012 to October 2018 was conducted. The goal of this review was to analyze the efficacy and safety of invasive (implantable) peripheral neurostimulation methods (the occipital nerve, the cervical branch of vagal nerve, the sphenopalatine ganglion) and non-invasive (transcutaneous) peripheral neurostimulation methods (the occipital nerve, the supraorbital nerve, and the cervical and auricular branches of the vagal nerve), based on the results of published clinical trials and case series. Acting also on the peripheral nervous system, peripheral nerve (i.e. greater occipital nerve) and ganglion (i.e. sphenopalatine ganglion) blockades, botulinum neurotoxin type A-hemagglutinin complex therapies, and calcitonin generelated peptide-related monoclonal antibody treatments in this patient population are also discussed. Expert opinion: This review summarizes the latest results on the therapeutic strategies acting on the periphery in primary headache disorders. These therapeutic options are minimally invasive or noninvasive, efficacious, safe, and well tolerated. ARTICLE HISTORY

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“…Occipital nerve stimulation, including the use of the Bion microstimulator, has been used in cluster headache [ 76 , 77 , 80 , 88 – 90 ]; in addition to this, it has been used in other TACs. In hemicrania continua [ 75 , 90 , 91 ] and more recently in a prospective open-label case series of 16 HC patients, 50% (8/16) of the patients had a favorable response, defined as a more than 50% reduction in monthly moderate to severe headache days [ 92 ]. There are 2 case series involving SUNCT/SUNA [ 93 , 94 ], in the latter, the authors reported 77% of their 31 medically refractory patients had a more than 50% reduction in daily attack frequency with ONS [ 94 ].…”

Section: Peripheral Neuromodulation Targetsmentioning

confidence: 99%

Therapeutic Approaches for the Management of Trigeminal Autonomic Cephalalgias

Wei

Jensen

2018

Neurotherapeutics

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Trigeminal autonomic cephalalgia (TAC) encompasses 4 unique primary headache types: cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms. They are grouped on the basis of their shared clinical features of unilateral headache of varying durations and ipsilateral cranial autonomic symptoms. The shared clinical features reflect the underlying activation of the trigeminal–autonomic reflex. The treatment for TACs has been limited and not specific to the underlying pathogenesis. There is a proportion of patients who are refractory or intolerant to the current standard medical treatment. From instrumental bench work research and neuroimaging studies, there are new therapeutic targets identified in TACs. Treatment has become more targeted and aimed towards the pathogenesis of the conditions. The therapeutic targets range from the macroscopic and structural level down to the molecular and receptor level. The structural targets for surgical and noninvasive neuromodulation include central neuromodulation targets: posterior hypothalamus and, high cervical nerves, and peripheral neuromodulation targets: occipital nerves, sphenopalatine ganglion, and vagus nerve. In this review, we will also discuss the neuropeptide and molecular targets, in particular, calcitonin gene-related peptide, somatostatin, transient receptor potential vanilloid-1 receptor, nitric oxide, melatonin, orexin, pituitary adenylate cyclase-activating polypeptide, and glutamate.Electronic supplementary materialThe online version of this article (10.1007/s13311-018-0618-3) contains supplementary material, which is available to authorized users.

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Treatment of intractable hemicrania continua by occipital nerve stimulation

Cited by 16 publications

References 5 publications

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

Therapeutic Approaches for the Management of Trigeminal Autonomic Cephalalgias

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