title: Cluster headache attack remission with sphenopalatine ganglion stimulation: experiences in chronic cluster headache patients through 24 months.
abstract: BACKGROUND
  Cluster headache (CH) is a debilitating headache disorder with severe consequences for patient quality of life. On-demand neuromodulation targeting the sphenopalatine ganglion (SPG) is effective in treating the acute pain and a subgroup of patients experience a decreased frequency of CH attacks.
  
  
  METHODS
  We monitored self-reported attack frequency, headache disability, and medication intake in 33 patients with medically refractory, chronic CH (CCH) in an open label follow-up study of the original Pathway CH-1 study. Patients were followed for at least 24 months (average 750 ± 34 days, range 699-847) after insertion of an SPG microstimulator. Remission periods (attack-free periods exceeding one month, per the ICHD 3 (beta) definition) occurring during the 24-month study period were characterized. Attack frequency, acute effectiveness, medication usage, and questionnaire data were collected at regular clinic visits. The time point "after remission" was defined as the first visit after the end of the remission period.
  
  
  RESULTS
  Thirty percent (10/33) of enrolled patients experienced at least one period of complete attack remission. All remission periods followed the start of SPG stimulation, with the first period beginning 134 ± 86 (range 21-272) days after initiation of stimulation. On average, each patient's longest remission period lasted 149 ± 97 (range 62-322) days. The ability to treat acute attacks before and after remission was similar (37 % ± 25 % before, 49 % ± 32 % after; p = 0.2188). Post-remission headache disability (HIT-6) was significantly improved versus baseline (67.7 ± 6.0 before, 55.2 ± 11.4 after; p = 0.0118). Six of the 10 remission patients experienced clinical improvements in their preventive medication use. At 24 months post insertion headache disability improvements remained and patient satisfaction measures were positive in 100 % (10/10).
  
  
  CONCLUSIONS
  In this population of 33 refractory CCH patients, in addition to providing the ability to treat acute attacks, neuromodulation of the SPG induced periods of remission from cluster attacks in a subset of these. Some patients experiencing remission were also able to reduce or stop their preventive medication and remissions were accompanied by an improvement in headache disability.
authors.affiliation: Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark. mads.christian.johannes.barloese@regionh.dk.|Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet-Glostrup, Copenhagen, Denmark. mads.christian.johannes.barloese@regionh.dk.
authors.forename: Mads C J
authors.identifier: http://orcid.org/0000-0003-1046-2586
authors.initials: MC
authors.lastname: Barloese
authors.affiliation: Department of Neurology, University Medical Center Rostock, Rostock, Germany.|Department of Systems Neuroscience, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Tim P
authors.initials: TP
authors.lastname: Jürgens
authors.affiliation: Department of Systems Neuroscience, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: May
authors.affiliation: Department of Neurology, Hospital Clinico Universitario, Universidad Católica de Valencia, Valencia, Spain.
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Lainez
authors.affiliation: Headache Research Unit. Department of Neurology - CHR Citadelle, Liège University, Liège, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Schoenen
authors.affiliation: Migraine- and Headache Clinic Königstein, Königstein, Germany.
authors.forename: Charly
authors.initials: C
authors.lastname: Gaul
authors.affiliation: Clinical Research, Autonomic Technologies, Redwood City, California, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Goodman
authors.affiliation: Clinical Research, Autonomic Technologies, Redwood City, California, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Caparso
authors.affiliation: Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rigmor Højland
authors.initials: RH
authors.lastname: Jensen
mesh_terms: D000328:Adult; D003027:Cluster Headache / Q000175:diagnosis* / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005726:Ganglia, Parasympathetic / Q000502:physiology; D020773:Headache Disorders / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012074:Remission Induction / Q000379:methods; D013997:Time Factors
keywords: Cluster headache; Neuromodulation; Neurostimulation; Remission; Sphenopalatine ganglion