Clinical and mechanistic studies of occipital nerve stimulation for cluster headache and hemicrania continua.
Doctoral thesis, UCL (University College London).
Objectives: Assess long term efficacy and safety of occipital nerve stimulation (ONS) for medically intractable chronic cluster headache (CCH) and hemicrania continua (HC). Assess the feasibility of a micro neurostimulator ("bion") for providing ONS. Investigate if improvement in headache during ONS is opioid and/or GABAA receptor mediated. Background: ONS has been reported to be effective for patients with medically intractable CCH and HC in small open label studies but more data on is long term efficacy and safety is required. ONS is currently performed by implantable pulse generators (IPGs) with electrodes attached. The mechanism of action of ONS is poorly understood, with very few studies performed. Methods: Three studies: Retrospective assessment of 14 patients with medically intractable CCH implanted with an IPG and bilateral electrodes. Prospective, crossover study for six patients with HC implanted with a bion ipsilateral to their HC. Prospective, double blind, randomised, controlled, crossover study of opioid and GABAA receptor mediated mechanisms for three HC patients with ONS. Naloxone and flumazenil drugs were used. Results: At median follow up of 17.5 (range 4-35) months, ten medically intractable CCH patients improved by 20-95% and nine of these recommend ONS. No patients were worse. Adverse events of concern were lead migrations and battery depletion. At median follow up of 13.5 (range 6-21) months, five HC patients improved by 30-95% and one was worse by 20%. Five patients recommend ONS. Mild adverse events occurred, mostly consisting of transient over-stimulation. No consistent changes in pain severity occurred at times related to naloxone and flumazenil administration for any group. Conclusions: ONS provides a safe therapeutic option for some patients with medically intractable CCH and HC. Opioid or GABA mediated ONS mechanisms were not demonstrated. Larger studies are required to further our understanding of ONS.
|Title:||Clinical and mechanistic studies of occipital nerve stimulation for cluster headache and hemicrania continua|
|Additional information:||Authorisation for digitisation not received|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Neurology > Brain Repair and Rehabilitation|
Archive Staff Only