title: Occipital nerve stimulation improves the quality of life in medically-intractable chronic cluster headache: Results of an observational prospective study.
abstract: Background Occipital nerve stimulation (ONS) has been proposed to treat chronic medically-intractable cluster headache (iCCH) in small series of cases without evaluation of its functional and emotional impacts. Methods We report the multidimensional outcome of a large observational study of iCCH patients, treated by ONS within a nationwide multidisciplinary network ( https://clinicaltrials.gov NCT01842763), with a one-year follow-up. Prospective evaluation was performed before surgery, then three and 12 months after. Results One year after ONS, the attack frequency per week was decreased >30% in 64% and >50% in 59% of the 44 patients. Mean (Standard Deviation) weekly attack frequency decreased from 21.5 (16.3) to 10.7 (13.8) ( p = 0.0002). About 70% of the patients responded to ONS, 47.8% being excellent responders. Prophylactic treatments could be decreased in 40% of patients. Functional (HIT-6 and MIDAS scales) and emotional (HAD scale) impacts were significantly improved, as well as the health-related quality of life (EQ-5D). The mean (SD) EQ-5D visual analogic scale score increased from 35.2 (23.6) to 51.9 (25.7) ( p = 0.0037). Surgical minor complications were observed in 33% of the patients. Conclusion ONS significantly reduced the attack frequency per week, as well as the functional and emotional headache impacts in iCCH patients, and dramatically improved the health-related quality of life of responders.
authors.affiliation: 1 Dept. of Neurosurgery, CHU de Nice, Nice, France.|2 Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte d'Azur, Nice, France.
authors.forename: Denys
authors.initials: D
authors.lastname: Fontaine
authors.affiliation: 3 Dept. of Neurosurgery, CHU de Lille, Lille, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Blond
authors.affiliation: 4 Dept. of Neurology, CHU de Lille, Lille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Lucas
authors.affiliation: 5 Dept. of Functional Neurosurgery, Aix-Marseille University, La Timone Hospital, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Regis
authors.affiliation: 2 Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte d'Azur, Nice, France.|6 Pain Clinic, La Timone Hospital, Marseille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Donnet
authors.affiliation: 7 Dept. of Neurosurgery, CHU de Rouen, Rouen, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Derrey
authors.affiliation: 8 Dept. of Neurology, CHU de Rouen, Rouen, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Guegan-Massardier
authors.affiliation: 9 Dept. of Neurosurgery, Foch Hospital, Suresnes, France.
authors.forename: Bechir
authors.initials: B
authors.lastname: Jarraya
authors.affiliation: 10 Dept. of Neurology, Foch Hospital, Suresnes, France.
authors.forename: Bich
authors.initials: B
authors.lastname: Dang-Vu
authors.affiliation: 10 Dept. of Neurology, Foch Hospital, Suresnes, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Bourdain
authors.affiliation: 11 Emergency Headache Centre, Lariboisière Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Valade
authors.affiliation: 11 Emergency Headache Centre, Lariboisière Hospital, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Roos
authors.affiliation: 12 Dept. of Neurology, CHU de Saint Etienne, Saint Etienne, France.
authors.forename: Christèle
authors.initials: C
authors.lastname: Creach
authors.affiliation: 13 Dept. of Neurosurgery, CHU de Grenoble-Alpes, Grenoble, France.
authors.forename: Stéphan
authors.initials: S
authors.lastname: Chabardes
authors.affiliation: 14 Dept. of Neurology, d'Annecy Hospital, Annecy, France.
authors.forename: Pierric
authors.initials: P
authors.lastname: Giraud
authors.affiliation: 15 Dept. of Neurosurgery, CHG de Colmar, Colmar, France.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Voirin
authors.affiliation: 16 Dept. of Neurosurgery, CHUV, Lausanne, Switzerland.
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Bloch
authors.affiliation: 16 Dept. of Neurosurgery, CHUV, Lausanne, Switzerland.
authors.forename: Alda
authors.initials: A
authors.lastname: Rocca
authors.affiliation: 17 Dept. of Neurosurgery, CHU de Nancy, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Colnat-Coulbois
authors.affiliation: 18 Dept. of Neurosurgery, CHU de Limoges, Limoges, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Caire
authors.affiliation: 19 Dept. of Clinical Research and Innovation, CHU de Nice, Nice, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Roger
authors.affiliation: 20 Pain Clinic, CHU de Nice, Nice, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Romettino
authors.affiliation: 2 Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte d'Azur, Nice, France.|20 Pain Clinic, CHU de Nice, Nice, France.|21 INSERM/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Clermont-Ferrand, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Lanteri-Minet
mesh_terms: D000328:Adult; D000368:Aged; D003027:Cluster Headache / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cluster headache; EQ-5D; intractable; neuromodulation; occipital nerve stimulation; quality of life