Open AccessOccipital Nerve Stimulation with the Bion® Microstimulator for the Treatment of Medically Refractory Chronic Cluster Headache
Author(s) -
Natalie Strand,
Terrence L. Trentman,
Bert B. Vargas,
David W. Dodick
Publication year - 2011
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2011/14/435
Subject(s) - cluster headache , medicine , occipital nerve stimulation , chronic pain , refractory (planetary science) , adverse effect , observational study , implant , anesthesia , prospective cohort study , surgery , physical therapy , migraine , physics , alternative medicine , pathology , astrobiology
Background: Chronic cluster headache is a severely disabling neurological disorder.Evidence from open-label case series suggest that occipital nerve stimulation may beeffective for the treatment of chronic cluster headache.Objective: To evaluate the effectiveness of a microstimulator for chronic clusterheadache.Study Design: Prospective, observational feasibility study plus medical record review.Settings: Academic medical center.Methods: Four patients with medically refractory chronic cluster headache underwentimplantation of a unilateral bion microstimulator. In-person follow-up was conductedfor 12 months after implantation, and a prospective follow-up chart review was carriedout to assess long term outcome.Results: Three of the participants returned their headache diaries for evaluation. Themean duration of chronic cluster headache was 14.3 years (range 3 to 29 years). Painwas predominantly or exclusively retroocular/periocular. One participant demonstrateda positive response (> 50% reduction in cluster headache frequency) at 3 months postimplant, while there were 2 responders at 6 months. At least one of the participantscontinued to show > 60% reduction in headache frequency at 12 months. A chartreview showed that at 58-67 months post-implant, all 3 participants reported continueduse and benefit from stimulation. No side-shift in attacks was noted in any participant.Adverse events were limited to 2 participants with neck pain and/or cramping withstimulation at high amplitudes; one required revision for a faulty battery.Limitations: Small patient population without control group. Not blinded orrandomized.Conclusion: Unilateral occipital nerve stimulation, using a minimally invasivemicrostimulator, may be effective for the treatment of medically refractory chroniccluster headache. This benefit may occur immediately after implantation, remainsustained up to 5 years after implantation, and occur despite the anterior locationof the pain. Prospective, randomized controlled trials of occipital nerve stimulation inchronic cluster headache should proceed.Key words: chronic headache, bion, peripheral nerve stimulation, cluster headache,migraine, occipital