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Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients

From the Headache Group (B.B., P.J.G.) and Division of Neurosurgery (L.W.), Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco.

Address correspondence and reprint requests to Professor P.J. Goadsby, Headache Group, Department of Neurology, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 19143-0114 peterg{at}headache.ucsf.edu

Background: Cluster headache is a primary headache involving repeated attacks of excruciatingly severe headache usually occurring several times a day. Most patients with chronic cluster headache (CCH) have an unremitting illness requiring daily preventive therapy for years.

Objective: To describe the clinical outcome of occipital nerve stimulation (ONS) for 14 patients with intractable CCH.

Methods: Fourteen patients with medically intractable CCH were implanted with bilateral electrodes in the suboccipital region for ONS and a retrospective assessment of their clinical outcome obtained.

Results: At a median follow-up of 17.5 months (range 4–35 months), 10 of 14 patients reported improvement and 9 of these recommend ONS. Three patients noticed a marked improvement of 90% or better (90%, 90%, and 95%), 3 a moderate improvement of 40% or better (40%, 50%, and 60%), and 4 a mild improvement of 20–30% (20%, 20%, 25%, and 30%). Improvement occurred within days to weeks for those who responded most and patients consistently reported their attacks returned within hours to days when the device was off. One patient found that ONS helped abort acute attacks. Adverse events of concern were lead migrations and battery depletion.

Conclusion: Intractable chronic cluster headache (CCH) is a devastating, disabling condition that has traditionally been treated with cranially invasive or neurally destructive procedures. ONS offers a safe, effective option for some patients with CCH. More work is required to evaluate and understand this novel therapy.

CCH = chronic cluster headache; DBS = deep brain stimulation; DHE = dihydroergotamine; ONS = occipital nerve stimulation.

Supplemental data at www.neurology.org

Disclosure: The study had no external support from conception through data collection, analysis, and manuscript preparation. B.B., L.W., and P.J.G. receive financial support for other unrelated studies of neurostimulation therapy in headache from Medtronic and Advanced Bionics.

Received July 30, 2008. Accepted in final form October 21, 2008.

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				Occipital Nerve Stimulation for Chronic Cluster Headache Journal Watch Neurology, March 31, 2009; 2009(331): 4 - 4. [Full Text]