title: Treatment of intractable chronic cluster headache by occipital nerve stimulation: a cohort of 51 patients.
abstract: Chronic cluster headache is a rare, highly disabling primary headache condition. When medically intractable, occipital nerve stimulation can offer effective treatment. Open-label series have provided data on small cohorts only.
  
  
  
  We analyzed 51 subjects to evaluate the long-term outcomes of highly intractable chronic cluster headache with occipital nerve stimulation. Patients with intractable chronic cluster headache were implanted with occipital nerve stimulators during the period 2007-2014. The primary endpoint was improvement in daily attack frequency. Secondary endpoints included attack severity, attack duration, quality-of-life measures, headache disability scores and adverse events.
  
  
  
  We studied 51 patients [35 males; mean age at implant 47.78 (range 31-70) years; mean follow-up 39.17 (range 2-81) months]. Nineteen patients had other chronic headache types in addition in chronic cluster headache. At final follow-up, there was a 46.1% improvement in attack frequency (P < 0001) across all patients, 49.5% (P < 0.001) in those with cluster headache alone and 40.3% (P = 0.036) in those with multiple phenotypes. There were no significant differences in response in those with or without multiple headache types. The overall response rate (defined as at least a 50% improvement in attack frequency) was 52.9%. Significant reductions were also seen in attack duration and severity. Improvements were noted in headache disability scores and quality-of-life measures. Triptan use of responders dropped by 62.56%, resulting in significant cost savings. Adverse event rates were highly favorable.
  
  
  
  Occipital nerve stimulation appears to be a safe and efficacious treatment for highly intractable chronic cluster headache even after a mean follow-up of over 3 years.
authors.affiliation: Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London.
authors.forename: S
authors.initials: S
authors.lastname: Miller
authors.affiliation: Department of Neurosurgery, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Watkins
authors.affiliation: Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London.
authors.forename: M
authors.initials: M
authors.lastname: Matharu
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003027:Cluster Headache / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D004351:Drug Resistance; 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; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome; D014363:Tryptamines / Q000627:therapeutic use
chemical_list: D014363:Tryptamines
keywords: cluster headache; headache; neurostimulation; occipital nerve stimulation