scholarly journals Central modulation in cluster headache patients treated with occipital nerve stimulation: an FDG-PET study

BMC Neurology ◽  
2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Delphine Magis ◽  
Marie-Aurélie Bruno ◽  
Arnaud Fumal ◽  
Pierre-Yves Gérardy ◽  
Roland Hustinx ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Fdg Pet ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Headache Patients

Long-term occipital nerve stimulation for drug-resistant chronic cluster headache

Cephalalgia ◽  
2016 ◽  
Vol 37 (8) ◽  
pp. 756-763 ◽  
Author(s):  
Massimo Leone ◽  
Alberto Proietti Cecchini ◽  
Giuseppe Messina ◽  
Angelo Franzini
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Stable Condition ◽  
Chronic Cluster Headache ◽  
Drug Resistant ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Headache Patients

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.

Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study: Rationale and protocol of a randomised trial

Cephalalgia ◽  
2013 ◽  
Vol 33 (15) ◽  
pp. 1238-1247 ◽  
Author(s):  
Leopoldine A Wilbrink ◽  
Onno PM Teernstra ◽  
Joost Haan ◽  
Erik W van Zwet ◽  
Silvia MAA Evers ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Randomised Trial ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Double Blind ◽  
Effective Prevention ◽  
Occipital Nerve ◽  
Low Amplitude ◽  
Headache Patients

Background About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled neuromodulation studies in treatments inducing paraesthesias have a general problem in blinding. We have introduced a new design in pain neuromodulation by which we think we can overcome this problem. Methods/design We propose a prospective, randomised, double-blind, parallel-group international clinical study in medically intractable, chronic cluster headache patients of high- versus low-amplitude ONS. Primary outcome measure is the mean number of attacks over the last four weeks. After a study period of six months there is an open extension phase of six months. Alongside the randomised trial an economic evaluation study is performed. Discussion The ICON study will show if ONS is an effective preventive therapy for patients suffering medically intractable chronic cluster headache and if there is a difference between high- and low-amplitude stimulation. The innovative design of the study will, for the first time, assess efficacy of ONS in a blinded way.

scholarly journals Burst Occipital Nerve Stimulation for Chronic Migraine and Chronic Cluster Headache

2019 ◽  
Vol 22 (5) ◽  
pp. 638-644 ◽  
Author(s):  
Rodrigo Garcia‐Ortega ◽  
Tamara Edwards ◽  
Liz Moir ◽  
Tipu Z. Aziz ◽  
Alexander L. Green ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve

Occipital nerve block prior to occipital nerve stimulation for refractory chronic migraine and chronic cluster headache: Myth or prediction?

Cephalalgia ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 359-362 ◽  
Author(s):  
Thomas M Kinfe ◽  
Patrick Schuss ◽  
Hartmut Vatter
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Nerve Block ◽  
Nerve Stimulation ◽  
Predictive Value ◽  
Positive Response ◽  
Chronic Cluster Headache ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Occipital Nerve Block

Background Occipital nerve stimulation (ONS) results in beneficial outcomes, with marked pain relief, in otherwise intractable chronic migraine (CM) and chronic cluster headache (CCH). Some studies have reported that a positive response to occipital nerve block (ONB) administered prior to ONS predicts a positive response to ONS. However, other studies concerned with proper patient selection claimed no predictive value for ONB. The aim of this study was to re-evaluate the usefulness and predictive value of ONB prior to ONS. Methods Literature searches on the predictive value of ONB were performed in MEDLINE and PubMed. Patient data were extracted and a pooled analysis was performed. Results The literature review revealed 133 patients with CM and seven patients with CCH who received preoperative ONB. To date, a randomized controlled study examining the relationship between ONB and ONS has not been conducted in patients with CM. Conclusions Current literature suggests that ONB does not sufficiently predict ONS responsiveness in patients with refractory CM and CCH; this important issue requires further investigation.

scholarly journals Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review

2019 ◽  
Vol 5 (22;5) ◽  
pp. 447-477
Author(s):  
Ajay Antony
Keyword(s):  
Peripheral Nerve ◽  
Cluster Headache ◽  
Nerve Stimulation ◽  
Facial Pain ◽  
Current Evidence ◽  
Occipital Neuralgia ◽  
Occipital Nerve Stimulation ◽  
Peripheral Nerve Stimulator ◽  
Occipital Nerve ◽  
Craniofacial Pain

Background: Head and facial pain is a common and often difficult to treat disorder. Routine treatments sometimes fail to provide acceptable relief, leaving the patient searching for something else, including narcotics and surgery. Recently, neuromodulation has been expanding to provide another option. Secondary to its potentially temporary nature and relatively manageable risk profile, several reviews have suggested trialing neuromodulation prior to starting narcotics or invasive permanent surgeries. There is evidence that neuromodulation can make a difference in those patients with intractable severe craniofacial pain. Objectives: To provide a basic overview of the anatomy, epidemiology, pathophysiology and common treatments of several common head and facial disorders. Furthermore, to demonstrate the suggested mechanisms of neuromodulation and the evidence currently existing for the use of neuromodulation. Methods: A comprehensive review was performed regarding the available literature through targeting articles reporting on the use of neuromodulation to treat pain of the head and face. Results: We compiled and discuss the current evidence available in treating head and facial pain. The strongest evidence currently for neuromodulation is for occipital nerve stimulation for migraine, transcutaneous vagal nerve stimulation for migraine and cluster headache, sphenopalatine ganglion microstimulation for cluster headache, and transcutaneous supraorbital and supratrochlear nerve stimulation for migraine. In addition, there is moderate evidence for occipital nerve stimulation in treating occipital neuralgia. Limitations: Neuromodulation has been trialed and is promising in several craniofacial pain disorders; however, there remains a need for large-scale, randomized, placebo-controlled clinical trials to further evaluate the efficacy and safety of most treatments. Much of the current data relies on case reports without randomization or placebo controls. Conclusions: With advancing techniques and technology, neuromodulation can be promising in treating intractable pain of the head and face. Although more randomized controlled trials are warranted, the current literature supports the use of neuromodulation in intractable craniofacial pain. Key words: Neuromodulation, headache, facial pain, craniofacial pain, migraine, cluster headache, trigeminal neuralgia, occipital neuralgia, peripheral nerve stimulator, high cervical spinal cord stimulator, peripheral nerve field stimulator

scholarly journals Occipital nerve stimulation and deep brain stimulation for refractory cluster headache: a prospective analysis of efficacy over time

2020 ◽  
pp. 1-8
Author(s):  
Juan Ángel Aibar-Durán ◽  
María Jesús Álvarez Holzapfel ◽  
Rodrigo Rodríguez Rodríguez ◽  
Robert Belvis Nieto ◽  
Carles Roig Arnall ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Clinical Response ◽  
Brain Stimulation ◽  
Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Over Time ◽  
Deep Brain

OBJECTIVEOccipital nerve stimulation (ONS) and deep brain stimulation (DBS) are widely used surgical treatments for chronic refractory cluster headache (CH). However, there is little literature regarding long-term follow-up of these treatments.METHODSThe authors describe two prospective cohorts of patients with refractory CH treated with ONS and DBS and compare preoperative to postoperative status at 6 and 12 months after the surgery and at final follow-up. Efficacy analysis using objective and subjective variables is reported, as well as medication reduction and complications.RESULTSThe ONS group consisted of 13 men and 4 women, with a median age of 44 years (range 31–61 years). The median number of attacks per week (NAw) before surgery was 28 (range 7–70), and the median follow-up duration was 48 months. The DBS group comprised 5 men and 2 women, with a median age of 50 years (range 29–64 years). The median NAw before surgery was 56 (range 14–140), and the median follow-up was 36 months. The NAw and visual analog scale score were significantly reduced for the ONS and DBS groups after surgery. However, while all the patients from the DBS group were considered responders at final follow-up, with more than 85% being satisfied with the treatment, approximately 29% of initial responders to ONS became resistant by the final follow-up (p = 0.0253).CONCLUSIONSONS is initially effective as a treatment for refractory CH, although a trend toward loss of efficacy was observed. No clear predictors of good clinical response were found in the present study. Conversely, DBS appears to be effective and provide a more stable clinical response over time with an acceptable rate of surgical complications.

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