By Anthony J. Brown, MD

NEW YORK (Reuters Health) – The results of a small study suggest that occipital nerve stimulation is a safe treatment for intractable chronic cluster headache that can provide sustained relief for many patients.

“The most important finding,” senior author Dr. Peter J. Goadsby told Reuters Health, “is that the benefit of treatment lasted for years in patients who had previously had no more than weeks of relief on standard medicines. In such an intractable and difficult problem as chronic cluster headache, the effect really stands out from previous medical therapy.”

Intractable chronic cluster headache is a devastating condition that has traditionally been managed with cranially invasive procedures or with various types of nerve destruction, according to the report in the January 27th issue of Neurology.

The present study featured 14 patients who received occipital nerve stimulation via bilateral electrodes implanted in the suboccipital region. The median follow-up period was 17.5 months.

Ten patients reported symptomatic improvements and all but one of them said they would recommend occipital nerve stimulation. Marked improvements were reported by three patients, moderate improvements by three, and mild improvements by four.

The time to improvements ranged from immediate to several weeks. With stimulation off, the attacks returned in hours to days. In one case, stimulation was reported to abort attacks.

The most common treatment complication was battery depletion and six patients required replacements. Similarly, four patients required new leads or electrodes.

The take-home message, according to Dr. Goadsby, is that “difficult to treat headache problems are starting to yield to new therapies. The major message is optimism — if you were untreatable yesterday, you may be treatable today and with more research you will be treatable tomorrow.”

The major questions to be addressed in future studies “are how does (occipital nerve stimulation) work and how can we better establish early who will benefit,” he added.

Reference:
Neurology 2009;72:341-345.