Neurosurgery. 2020 Sep 28;nyaa373.
doi: 10.1093/neuros/nyaa373.

Aurélie Leplus, Denys Fontaine, Anne Donnet, Jean Regis, Christian Lucas, Nadia Buisset, Serge Blond, Sylvie Raoul, Evelyne Guegan-Massardier, Stéphane Derrey, Bechir Jarraya, Bich Dang-Vu, Frederic Bourdain, Dominique Valade, Caroline Roos, Christelle Creach, Stéphan Chabardes, Pierric Giraud, Jimmy Voirin, Jocelyne Bloch, Sophie Colnat-Coulbois, François Caire, Philippe Rigoard, Laurie Tran, Coralie Cruzel, Michel Lantéri-Minet , French ONS registry group

Background: Occipital nerve stimulation (ONS) has been proposed to treat refractory chronic cluster headache (rCCH) but its efficacy has only been showed in small short-term series.
Objective: To evaluate ONS long-term efficacy in rCCH. Methods: We studied 105 patients with rCCH, treated by ONS within a multicenter ONS prospective registry. Efficacy was evaluated by frequency, intensity of pain attacks, quality of life (QoL) EuroQol 5 dimensions (EQ5D), functional (Headache Impact Test-6, Migraine Disability Assessment) and emotional (Hospital Anxiety Depression Scale [HAD]) impacts, and medication consumption.
Results:At last follow-up (mean 43.8 mo), attack frequency was reduced >50% in 69% of the patients. Mean weekly attack frequency decreased from 22.5 at baseline to 9.9 (P < .001) after ONS. Preventive and abortive medications were significantly decreased. Functional impact, anxiety, and QoL significantly improved after ONS. In excellent responders (59% of the patients), attack frequency decreased by 80% and QoL (EQ5D visual analog scale) dramatically improved from 37.8/100 to 73.2/100. When comparing baseline and 1-yr and last follow-up outcomes, efficacy was sustained over time. In multivariable analysis, low preoperative HAD-depression score was correlated to a higher risk of ONS failure. During the follow-up, 67 patients experienced at least one complication, 29 requiring an additional surgery: infection (6%), lead migration (12%) or fracture (4.5%), hardware dysfunction (8.2%), and local pain (20%).
Conclusion: Our results showed that long-term efficacy of ONS in CCH was maintained over time. In responders, ONS induced a major reduction of functional and emotional headache-related impacts and a dramatic improvement of QoL. These results obtained in real-life conditions support its use and dissemination in rCCH patients.

PMID: 32985662 DOI: 10.1093/neuros/nyaa373

Keywords: Cluster headache; Intractable; Neuromodulation; Occipital nerve stimulation; Quality of life.

Copyright © 2020 by the Congress of Neurological Surgeons.

Long-Term Efficacy of Occipital Nerve Stimulation for Medically Intractable Cluster Headache