Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients

Burns, Brian; Watkins, Laurence; Goadsby, Peter J.

doi:10.1016/s0140-6736(07)60328-6

Cited by 321 publications

(237 citation statements)

References 47 publications

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“…Prominent symptom and pain laterality may indicate unilateral stimulation, while sideshift occurrence (68,77) may advocate for bilateral stimulation.…”

Section: Future Perspectivementioning

confidence: 99%

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

2013

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Objective: The objective of this article is to review the prospect of treating migraine with sphenopalatine ganglion (SPG) neurostimulation. Background: Fuelled by preliminary studies showing a beneficial effect in cluster headache patients, the potential of treating migraine with neurostimulation has gained increasing interest within recent years, as current treatment strategies often fail to provide adequate relief from this debilitating headache.Common migraine symptoms include lacrimation, nasal congestion, and conjunctival injection, all parasympathetic manifestations. In addition, studies have suggested that parasympathetic activity may also contribute to the pain of migraineurs.The SPG is the largest extracranial parasympathetic ganglion of the head, innervating the meninges, lacrimal gland, nasal mucosa, and conjunctiva, all structures involved in migraine with cephalic autonomic symptoms. Conclusion: We propose two possible mechanisms of action: 1) interrupting the post-ganglionic parasympathetic outflow to inhibit the pain and cephalic autonomic symptoms, and 2) modulating the sensory processing in the trigeminal nucleus caudalis. To further explore SPG stimulation in migraineurs as regards therapeutic potential and mode of action, randomized clinical trials are warranted.

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“…Prominent symptom and pain laterality may indicate unilateral stimulation, while sideshift occurrence (68,77) may advocate for bilateral stimulation.…”

Section: Future Perspectivementioning

confidence: 99%

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

2013

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“…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.…”

Section: Occipital Nerve Stimulation: Historymentioning

confidence: 99%

“…18 There are two published trials in chronic cluster headache, one prospective and one retrospective, but these trials are uncontrolled, as they offer no comparison to sham. 15,17 …”

Section: Occipital Nerve Stimulation: Historymentioning

confidence: 99%

Occipital Nerve Stimulation for Headache Disorders

Paemeleire

Bartsch

2010

Neurotherapeutics

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Summary:Occipital nerve stimulation (ONS) was originally described in the treatment of occipital neuralgia. However, the spectrum of possible indications has expanded in recent years to include primary headache disorders, such as migraine and cluster headaches. Retrospective and some prospective studies have yielded encouraging results, and evidence from controlled clinical trials is emerging, offering hope for refractory headache patients. In this article we discuss the scientific rationale to use ONS to treat headache disorders, with emphasis on the trigeminocervical complex. ONS is far from a standardized technique at the moment and the recent literature on the topic is reviewed, both with respect to the procedure and its possiblecomplications. An important way to move forward in the scientific evaluation of ONS to treat refractory headache is the clinical phenotyping of patients to identify patients groups with the highest likelihood to respond to this modality of treatment. This requires multidisciplinary assessment of patients. The development of ONS as a new treatment for refractory headache offers an exciting prospect to treat our most disabled headache patients. Data from ongoing controlled trials will undoubtedly shed new light on some of the unresolved questions.

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“…44,45 In addition, there could be higher-order processing implications. Studies in cluster headache 46 and hemicrania continua 47 suggest that this therapeutic approach may have generic use in primary headache disorders. More work is clearly required.…”

Section: Nerve Block and Device-based Strategiesmentioning

confidence: 99%

Headache

Goadsby

2010

Neurotherapeutics

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Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients

Cited by 321 publications

References 47 publications

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

Occipital Nerve Stimulation for Headache Disorders

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