title: High cervical spinal cord stimulation for chronic cluster headache.
abstract: 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.affiliation: University Hospital Freiburg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Wolter
authors.forename: Andrea
authors.initials: A
authors.lastname: Kiemen
authors.forename: Holger
authors.initials: H
authors.lastname: Kaube
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D003027:Cluster Headache / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013116:Spinal Cord / Q000502:physiology*