Long-term occipital nerve stimulation for drug-resistant chronic cluster headache

Authors: Massimo Leone, Alberto Proietti Cecchini, Giuseppe Messina, Angelo Franzini
Source: Cephalalgia, Volume: 37 issue: 8, page(s): 756-763


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.

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.

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.

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.

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