title: Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation.
abstract: 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.
authors: Centre Hospitalier Universitaire de Nice, France.
authors: Denys
authors: D
authors: Fontaine
authors: Jean
authors: J
authors: Christophe Sol
authors: Sylvie
authors: S
authors: Raoul
authors: Nelly
authors: N
authors: Fabre
authors: Gilles
authors: G
authors: Geraud
authors: Christine
authors: C
authors: Magne
authors: Charlotte
authors: C
authors: Sakarovitch
authors: Michel
authors: M
authors: Lanteri-Minet
mesh_terms: D000328:Adult; D003027:Cluster Headache / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome