Miller, S;
Watkins, L;
Matharu, M;
(2016)
Long-term outcomes of occipital nerve stimulation for chronic migraine: a cohort of 53 patients.
The Journal of Headache and Pain
, 17
, Article 68. 10.1186/s10194-016-0659-0.
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Abstract
BACKGROUND: Chronic migraine affects up to 2 % of the general population and has a substantial impact on sufferers. Occipital nerve stimulation has been investigated as a potentially effective treatment for refractory chronic migraine. Results from randomised controlled trials and open label studies have been inconclusive with little long-term data available. METHODS: The long-term efficacy, functional outcome and safety of occipital nerve stimulation was evaluated in an uncontrolled, open-label, prospective study of 53 intractable chronic migraine patients. RESULTS: Fifty-three patients were implanted in a single centre between 2007 and 2013. Patients had a mean age of 47.75 years (range 26-70), had suffered chronic migraine for around 12 years and had failed a mean of 9 (range 4-19) preventative treatments prior to implant. Eighteen patients had other chronic headache phenotypes in addition to chronic migraine. After a median follow-up of 42.00 months (range 6-97) monthly moderate-to-severe headache days (i.e. days on which pain was more than 4 on the verbal rating score and lasted at least 4 h) reduced by 8.51 days (p < 0.001) in the whole cohort, 5.80 days (p < 0.01) in those with chronic migraine alone and 12.16 days (p < 0.001) in those with multiple phenotypes including chronic migraine. Response rate of the whole group (defined as a >30 % reduction in monthly moderate-to-severe headache days) was observed in 45.3 % of the whole cohort, 34.3 % of those with chronic migraine alone and 66.7 % in those with multiple headache types. Mean subjective patient estimate of improvement was 31.7 %. Significant reductions were also seen in outcome measures such as pain intensity (1.34 points, p < 0.001), all monthly headache days (5.66 days, p < 0.001) and pain duration (4.54 h, p < 0.001). Responders showed substantial reductions in headache-related disability, affect scores and quality of life measures. Adverse event rates were favourable with no episodes of lead migration and only one minor infection reported. CONCLUSIONS: Occipital nerve stimulation may be a safe and efficacious treatment for highly intractable chronic migraine patients even after relatively prolonged follow up of a median of over 3 years.
Type: | Article |
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Title: | Long-term outcomes of occipital nerve stimulation for chronic migraine: a cohort of 53 patients |
Location: | Italy |
Open access status: | An open access version is available from UCL Discovery |
DOI: | 10.1186/s10194-016-0659-0 |
Publisher version: | http://doi.org/10.1186/s10194-016-0659-0 |
Language: | English |
Additional information: | Copyright © 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
Keywords: | Chronic migraine, Headache, Neurostimulation, Occipital nerve stimulation |
UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation |
URI: | https://discovery.ucl.ac.uk/id/eprint/1508187 |
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