Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation

• Published in: Cephalalgia Vol. 31; no. 10; pp. 1101 - 1105
• Main Authors: Fontaine, Denys, Christophe Sol, Jean, Raoul, Sylvie, Fabre, Nelly, Geraud, Gilles, Magne, Christine, Sakarovitch, Charlotte, Lanteri-Minet, Michel
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.07.2011
• Subjects: Adult; Cluster Headache - therapy; Electric Stimulation Therapy - adverse effects; Electric Stimulation Therapy - methods; Electrodes, Implanted - adverse effects; Female; Humans; Male; Middle Aged; Treatment Outcome; neuromodulation; Cluster headache; occipital nerve stimulation; greater occipital nerve
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1177/0333102411412086

Background: Greater occipital nerve stimulation (ONS) has been recently proposed to treat severe chronic cluster headache patients (CCH) refractory to medical treatment. We report the results of a French multidisciplinary cohort study. Methods: Thirteen CCH patients were operated and data were collected prospectively. All of them suffered from CCH according to the International Headache Society classification, lasting for more than 2 years, refractory to pharmacological prophylactic treatment with adequate trials, with at least one daily attack. Chronic ONS was delivered through a subcutaneous occipital electrode connected to an implanted generator, in order to induce paraesthesias perceived locally in the lower occipital region. Results: After surgery (mean follow-up 14,6 months), the mean attack frequency and intensity decreased by 68% and 49%, respectively. At last follow-up, 10/13 patients were considered as responders (improvement >50%). Prophylactic treatment could be stopped or reduced in 8/13 cases. Local infection occurred in one patient, leading to hardware removal. Conclusions: Our data confirmed the results of the 36 similar cases reported in the literature, suggesting that ONS may act as a prophylactic treatment in chronic CH. Considering their respective risks, ONS should be proposed before deep brain stimulation in severe refractory CCH patients.