Occipital nerve stimulation in drug-resistant cluster headache

Long-term experience in a Spanish tertiary centre showed that occipital nerve stimulation (ONS) is a beneficial treatment of drug-resistant chronic cluster headache (CCH). ONS reduced attack frequency without causing serious adverse events (AEs); this makes it a valid option for drug-resistant CCH management.

Dr Javier Membrilla (University Hospital La Paz, Spain) presented results from a retrospective observational study of 22 consecutive drug-resistant CCH patients who underwent ONS in a tertiary clinic [1]. This kind of study with long follow-up is scarce. The participants had drug-resistant CCH according to the EHF 2014 criteria and underwent ONS between March 2008 and July 2020. Baseline characteristics are listed in the Table. The procedure had 2 phases: temporary ONS for 2–7 weeks, followed by definitive ONS if there was a >50% improvement. The study's primary endpoint was weekly CCH attack reduction. Secondary endpoints were pain intensity on the visual analogue scale (VAS), patient-perceived overall improvement, and a decrease in oral medication use.

Table: Baseline patient characteristics [1]



After a median follow-up of 5 years, the weekly number of CCH attacks decreased from 30 at baseline to 22.5 after 3 months (P=0.012); 7.5 after 12 months (P=0.006); and 15.0 at the end of follow-up (P=0.023). From a median of 10, the VAS score decreased to 9.0 at 3 months (P=0.011); 7.0 at 12 months (P=0.008) and 7.0 at the end of follow-up (P=0.002). After 3 and 12 months, and after the end of follow-up, 23.5%, 41.2%, and 27.8% of patients had a perceived overall improvement of 70%. Of 22 participants, 13 (59%) reduced their prophylactic oral medication, while 3 (14%) stopped taking it altogether. All 22 participants decreased triptan use, 3 (14%) stopped using it. AEs were reported by 9 of 22 patients (41%) and were all mild. The most common AE was superficial surgical wound infection (n=4).

Dr Membrilla stated that further research is needed to identify characteristics of responders, so that ONS therapy can be offered to properly selected cases.

1. Membrilla J, et al. Occipital nerve stimulation in drug-resistant chronic cluster headache: a third-level hospital experience. OPR-067, EAN 2021 Virtual Congress, 19–22 June.

 

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Posted on 18 August 20218 February 2024