title: Long-term occipital nerve stimulation for drug-resistant chronic cluster headache.
abstract: Introduction Chronic cluster headache is rare and some of these patients become drug-resistant. Occipital nerve stimulation has been successfully employed in open studies to treat chronic drug-resistant cluster headache. Data from large group of occipital nerve stimulation-treated chronic cluster headache patients with long duration follow-up are advantageous. Patients and methods Efficacy of occipital nerve stimulation has been evaluated in an experimental monocentric open-label study including 35 chronic drug-resistant cluster headache patients (mean age 42 years; 30 men; mean illness duration: 6.7 years). The primary end-point was a reduction in number of daily attacks. Results After a median follow-up of 6.1 years (range 1.6-10.7), 20 (66.7%) patients were responders (≥50% reduction in headache number per day): 12 (40%) responders showed a stable condition characterized by sporadic attacks, five responders had a 60-80% reduction in headache number per day and in the remaining three responders chronic cluster headache was transformed in episodic cluster headache. Ten (33.3%) patients were non-responders; half of these have been responders for a long period (mean 14.6 months; range 2-48 months). Battery depletion (21 patients 70%) and electrode migration (six patients - 20%) were the most frequent adverse events. Conclusions Occipital nerve stimulation efficacy is confirmed in chronic drug-resistant cluster headaches even after an exceptional long-term follow-up. Tolerance can occur years after improvement.
authors.affiliation: 1 Department of Neurology, Headache Centre and Pain Neuromodulation Unit, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Leone
authors.affiliation: 1 Department of Neurology, Headache Centre and Pain Neuromodulation Unit, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Proietti Cecchini
authors.affiliation: 2 Department of Neurosurgery, Fondazione Istituto Nazionale Neurologico Carlo Besta, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.affiliation: 2 Department of Neurosurgery, Fondazione Istituto Nazionale Neurologico Carlo Besta, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzini
mesh_terms: D000328:Adult; D000368:Aged; D003027:Cluster Headache / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cluster headache; chronic; drug-resistant; neurostimulation; occipital nerve; treatment