Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients.
BACKGROUND
Cluster headache is a primary headache involving repeated attacks of excruciatingly severe headache usually occurring several times a day. Most patients with chronic cluster headache (CCH) have an unremitting illness requiring daily preventive therapy for years.


OBJECTIVE
To describe the clinical outcome of occipital nerve stimulation (ONS) for 14 patients with intractable CCH.


METHODS
Fourteen patients with medically intractable CCH were implanted with bilateral electrodes in the suboccipital region for ONS and a retrospective assessment of their clinical outcome obtained.


RESULTS
At a median follow-up of 17.5 months (range 4-35 months), 10 of 14 patients reported improvement and 9 of these recommend ONS. Three patients noticed a marked improvement of 90% or better (90%, 90%, and 95%), 3 a moderate improvement of 40% or better (40%, 50%, and 60%), and 4 a mild improvement of 20-30% (20%, 20%, 25%, and 30%). Improvement occurred within days to weeks for those who responded most and patients consistently reported their attacks returned within hours to days when the device was off. One patient found that ONS helped abort acute attacks. Adverse events of concern were lead migrations and battery depletion.


CONCLUSIONS
Intractable chronic cluster headache (CCH) is a devastating, disabling condition that has traditionally been treated with cranially invasive or neurally destructive procedures. ONS offers a safe, effective option for some patients with CCH. More work is required to evaluate and understand this novel therapy.
Burns
Brian
B
Headache Group, Department of Neurology, University of California San Francisco, San Francisco, CA 19143-0114, USA.
Watkins
Laurence
L
Goadsby
Peter J
PJ
D000328:Adult; D003027:Cluster Headache / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000502:physiology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome