title: A good preoperative response to transcutaneous electrical nerve stimulation predicts a better therapeutic effect of implanted occipital nerve stimulation in pharmacologically intractable headaches.
abstract: Occipital nerve stimulation (ONS) is a surgical approach to treat patients with medically intractable chronic headache disorders. However, no preoperative test has been yet validated to allow candidates to be selected for implantation. In this study, the analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) was tested for 1 to 3 months in 41 patients with pharmacologically intractable headache disorders of various origins, using a new technique of electrode placement over the occipital nerve. ONS electrodes were subsequently implanted in 33 patients (occipital neuralgia [n=15], cervicogenic headache [n=7], cluster headache [n=6], chronic migraine [n=5]) who had responded at least moderately to TENS. Assessment was performed up to five years after implantation (three years on average), based on the mean and maximum daily pain intensity scored on a 0-10 visual analogue scale and the number of headache days per month. Both TENS and chronic ONS therapy were found to be efficacious (57-76% improvement compared to baseline on the various clinical variables). The efficacy of ONS was better in cases of good or very good preoperative response to TENS than in cases of moderate response to TENS. Implanted ONS may be a valuable therapeutic option in the long term for patients with pharmacologically intractable chronic headache. Although we cannot conclude in patients with poor or no response to TENS, a good or very good response to TENS can support the indication of ONS therapy. This preoperative test could particularly be useful in patients with chronic migraine, in whom it may be difficult to indicate an invasive technique of cranial neurostimulation.
authors.affiliation: Multidisciplinary Pain, Palliative and Support Care Center, UIC22 and EA2826, University Hospital, 44093 Nantes cedex 1, France; Neurosurgery Department, University Hospital, 44093 Nantes cedex 1, France; Multidisciplinary Pain Center, clinique Brétéché, 44000 Nantes, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Nguyen
authors.affiliation: Multidisciplinary Pain, Palliative and Support Care Center, UIC22 and EA2826, University Hospital, 44093 Nantes cedex 1, France. Electronic address: julien.nizard@univ-nantes.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Nizard
authors.affiliation: Multidisciplinary Pain, Palliative and Support Care Center, UIC22 and EA2826, University Hospital, 44093 Nantes cedex 1, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Kuhn
authors.affiliation: Multidisciplinary Pain, Palliative and Support Care Center, UIC22 and EA2826, University Hospital, 44093 Nantes cedex 1, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Carduner
authors.affiliation: Multidisciplinary Pain, Palliative and Support Care Center, UIC22 and EA2826, University Hospital, 44093 Nantes cedex 1, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Penverne
authors.affiliation: Multidisciplinary Pain Center, clinique Brétéché, 44000 Nantes, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Verleysen-Robin
authors.affiliation: Neurosurgery Department, University Hospital, 44093 Nantes cedex 1, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Terreaux
authors.affiliation: Multidisciplinary Pain, Palliative and Support Care Center, UIC22 and EA2826, University Hospital, 44093 Nantes cedex 1, France.
authors.forename: Solène
authors.initials: S
authors.lastname: de Gaalon
authors.affiliation: Neurosurgery Department, University Hospital, 44093 Nantes cedex 1, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Raoul
authors.affiliation: Clinical Neurophysiology Department, Henri Mondor University Hospital, EA4391, Faculty of Medicine, UPEC, 94010 Créteil cedex, France.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D020773:Headache Disorders / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013127:Spinal Nerves / Q000503:physiopathology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Algie vasculaire de la face; Cervicogenic headache; Chronic headache; Chronic migraine; Cluster headache; Céphalée cervicogénique; Céphalée chronique; Migraine chronique; Neurostimulation électrique transcutanée; Névralgie occipitale; Occipital nerve stimulation; Occipital neuralgia; Stimulation du nerf occipital; Transcutaneous electrical nerve stimulation