Clomiphene Citrate as a Preventive Treatment for Intractable Chronic Cluster Headache: A Second Reported Case With Long-Term Follow-Up

Introduction Chronic cluster headache is rare and some of these patients become drug-resistant. Occipital nerve stimulation has been successfully employed in open studies to treat chronic drug-resistant cluster headache. Data from large group of occipital nerve stimulation-treated chronic cluster headache patients with long duration follow-up are advantageous. Patients and methods Efficacy of occipital nerve stimulation has been evaluated in an experimental monocentric open-label study including 35 chronic drug-resistant cluster headache patients (mean age 42 years; 30 men; mean illness duration: 6.7 years). The primary end-point was a reduction in number of daily attacks. Results After a median follow-up of 6.1 years (range 1.6–10.7), 20 (66.7%) patients were responders (≥50% reduction in headache number per day): 12 (40%) responders showed a stable condition characterized by sporadic attacks, five responders had a 60–80% reduction in headache number per day and in the remaining three responders chronic cluster headache was transformed in episodic cluster headache. Ten (33.3%) patients were non-responders; half of these have been responders for a long period (mean 14.6 months; range 2–48 months). Battery depletion (21 patients 70%) and electrode migration (six patients – 20%) were the most frequent adverse events. Conclusions Occipital nerve stimulation efficacy is confirmed in chronic drug-resistant cluster headaches even after an exceptional long-term follow-up. Tolerance can occur years after improvement.

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Retro-Gasserian Glycerol Injection in the Treatment of Chronic Cluster Headache

Cephalalgia ◽

10.1046/j.1468-2982.1987.0701021.x ◽

1987 ◽

Vol 7 (1) ◽

pp. 21-27 ◽

Cited By ~ 38

Author(s):

Karl Ekbom ◽

Lars Lindgren ◽

Bengt Y Nilsson ◽

Jan Erik Hardebo ◽

Elisabet Waldenlind

Keyword(s):

Cluster Headache ◽

Quantitative Estimation ◽

Close Correlation ◽

Chronic Cluster Headache ◽

Sensory Loss ◽

Complete Relief ◽

Thermal Perception ◽

Glycerol Injection ◽

Long Term Follow Up

Seven therapy-resistant patients with cluster headache (six of whom were chronic) were treated by percutaneous retro-Gasserian glycerol injections under general anesthesia. In four of the patients immediate and complete relief of attacks was obtained. There was a close correlation between pain relief and the degree of ophthalmic sensory loss. Quantitative estimation of thresholds for thermal perception and pain showed a good correlation to clinically evaluated sensory loss. As the analgesia waned, headaches returned, and the glycerol injections had to be repeated. Two patients were still considerably improved after 5 1/2 and nearly 3 years, respectively. In the other patients the results were less satisfactory at long-term follow-up study. Pure glycerol is highly hypertonic, and the damage of the trigeminal nerve root may be due to this property.

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Cluster headache in children and adolescents: Ten years of follow-up in three pediatric cases

Cephalalgia ◽

10.1177/0333102411418015 ◽

2011 ◽

Vol 31 (13) ◽

pp. 1409-1414 ◽

Cited By ~ 18

Author(s):

Marco A Arruda ◽

Lucas Bonamico ◽

Cleiber Stella ◽

Carlos A Bordini ◽

Marcelo E Bigal

Keyword(s):

Case Report ◽

Cluster Headache ◽

Spontaneous Remission ◽

Response To Therapy ◽

Case Examples ◽

The Third ◽

First Case ◽

Long Term Follow Up

Background: Cluster headache (CH) is a rare cause of headache in children. Onset before 12 years of age is unusual, and long-term follow-up of pediatric cases has been not reported. Objectives: To report three cases of CH with onset at childhood and at least ten years of follow-up. Methods: Case report. Results: The first case is that of a 12-year-old boy with episodic CH with unilateral pain and striking, bilateral autonomic manifestations, remitted for over eight years. The second case is unique in that it reports a case of chronic CH in a 13-year-old boy with Down syndrome. The third case is that of a 9-year-old girl with episodic CH with remissions of 2 and 5 years. All cases had prominent autonomic features. The frequency and duration of the attacks were similar to those that have been reported in adults. Good response to indomethacin was obtained in two cases, although tolerability issues occurred in one. Conclusion: Sustained, long-term, medical and/or spontaneous remission occurs in CH of early onset. The phenotype and response to therapy in children, at least in these case examples, are similar to equivalent observations in adult patients with CH.

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Long-term follow-up of laparoscopic electrocautery of the ovaries versus ovulation induction with recombinant FSH in clomiphene citrate-resistant women with polycystic ovary syndrome: an economic evaluation

Human Reproduction ◽

10.1093/humrep/des336 ◽

2012 ◽

Vol 27 (12) ◽

pp. 3577-3582 ◽

Cited By ~ 11

Author(s):

M. J. Nahuis ◽

E. Oude Lohuis ◽

N. Kose ◽

N. Bayram ◽

P. Hompes ◽

...

Keyword(s):

Economic Evaluation ◽

Polycystic Ovary Syndrome ◽

Ovulation Induction ◽

Polycystic Ovary ◽

Clomiphene Citrate ◽

Recombinant Fsh ◽

Ovary Syndrome ◽

Long Term Follow Up

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

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1088459.541520 ◽

2007 ◽

Author(s):

Anna Cohen

Keyword(s):

Cluster Headache ◽

Nerve Stimulation ◽

Occipital Nerve Stimulation ◽

Occipital Nerve ◽

Long Term Follow Up

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

Brain Sciences ◽

10.3390/brainsci11020236 ◽

2021 ◽

Vol 11 (2) ◽

pp. 236

Author(s):

Javier Díaz-de-Terán ◽

Javier A. Membrilla ◽

José Paz-Solís ◽

Iñigo de Lorenzo ◽

Javier Roa ◽

...

Keyword(s):

Adverse Events ◽

Cluster Headache ◽

Nerve Stimulation ◽

Chronic Cluster Headache ◽

Oral Medication ◽

Drug Resistant ◽

Occipital Nerve Stimulation ◽

Occipital Nerve

Occipital nerve stimulation (ONS) is a surgical treatment proposed for drug-resistant chronic cluster headache (drCCH). Long-term series assessing its efficacy are scarce. We designed a retrospective observational study with consecutive sampling, evaluating the follow-up of 17 drCCH patients who underwent ONS. Our main endpoint was the reduction the rate of attacks per week. We also evaluated the pain intensity through the Visual Analogue Scale (VAS), patient overall perceived improvement and decrease in oral medication intake. After a median follow-up of 6.0 years (4.5–9.0), patients decreased from a median of 30 weekly attacks to 22.5 (5.6–37.5, p = 0.012), 7.5 at 1 year (p = 0.006) and 15.0 at the end of follow-up (p = 0.041). The VAS decreased from a median of 10.0 to 8.0 (p = 0.011) at three months, to 7.0 (p = 0.008) at twelve months and 7.0 (p = 0.003) at the end of the follow-up. A total of 23.5% had an overall perceived improvement of ≥70% at 3 months, 41.2% at 1 year and 27.8% at the end of follow-up. Reducing prophylactic oral medication was possible in 76.5% and it was stopped in 17.7%. Triptan use decreased in all the responder patients and 17.7% stopped its intake. A total of 41.2% presented mild adverse events. In conclusion, our long-term experience suggests that ONS could be an interesting option for drCCH-selected patients, as it is a beneficial and minimally invasive procedure with no serious adverse events.

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