BACKGROUND: Cluster headache (CH) is the most painful and debilitating primary headache syndrome. Conventional treatment combines acute and prophylactic drugs. Also with maximal therapy a substantial proportion of patients do not experience a meaningful prevention or pain relief. Recent case series and early trials have suggested that occipital nerve stimulation can be very effective in the management of intractable CH. METHODS: Seven patients with medically intractable chronic cluster headache were implanted with high cervical epidural electrodes. After a median test phase of 10 days (range 4-19 days) an impulse generator was implanted subcutaneously. Mean follow up was 23 months (median 12 months, range 3-78 months). RESULTS: All patients showed significant treatment effects. In all patients, improvement occurred immediately after electrode implantation. The mean attack frequency decreased, as well as the mean duration and intensity of attacks. Also, depression, anxiety, and pain-related impairment scores decreased and medication intake was markedly reduced. CONCLUSIONS: In this prospective series, high cervical spinal cord stimulation shows an effect size equal or larger than occipital nerve stimulation with immediate onset after surgery and may serve as a valuable additional treatment option of intractable cluster headache in the future.
BACKGROUND:Cluster headache (CH) is the most painful and debilitating primary headache syndrome. Conventional treatment combines acute and prophylactic drugs. Also with maximal therapy a substantial proportion of patients do not experience a meaningful prevention or pain relief. Recent case series and early trials have suggested that occipital nerve stimulation can be very effective in the management of intractable CH. METHODS: Seven patients with medically intractable chronic cluster headache were implanted with high cervical epidural electrodes. After a median test phase of 10 days (range 4-19 days) an impulse generator was implanted subcutaneously. Mean follow up was 23 months (median 12 months, range 3-78 months). RESULTS: All patients showed significant treatment effects. In all patients, improvement occurred immediately after electrode implantation. The mean attack frequency decreased, as well as the mean duration and intensity of attacks. Also, depression, anxiety, and pain-related impairment scores decreased and medication intake was markedly reduced. CONCLUSIONS: In this prospective series, high cervical spinal cord stimulation shows an effect size equal or larger than occipital nerve stimulation with immediate onset after surgery and may serve as a valuable additional treatment option of intractable cluster headache in the future.
Authors: Rafael Caiado Vencio; Paulo Eduardo Albuquerque Zito Raffa; André Costa Corral Ponce; Bruno Pricoli Malamud; César Cozar Pacheco; Paulo Roberto Franceschini; Roger Thomaz Rotta Medeiros; Paulo Henrique Pires de Aguiar Journal: Surg Neurol Int Date: 2021-04-26
Authors: Paolo Martelletti; Rigmor H Jensen; Andrea Antal; Roberto Arcioni; Filippo Brighina; Marina de Tommaso; Angelo Franzini; Denys Fontaine; Max Heiland; Tim P Jürgens; Massimo Leone; Delphine Magis; Koen Paemeleire; Stefano Palmisani; Walter Paulus; Arne May Journal: J Headache Pain Date: 2013-10-21 Impact factor: 7.277