Artikel
A critical look at neuromodulative treatments for intractable headaches: ONS and SPG stimulation – the price we pay
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Autoren
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Daniela Pierscianek
- Klinik für Neurochirurgie, Universitätsklinikum Essen
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Anthony Caparso
- Autonomic Technologies, Redwood City, California, USA
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Kasja Rabe
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen
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Charly Gaul
- Migräne- und Kopfschmerzklinik, Königstein
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Oliver Mueller
- Klinik für Neurochirurgie, Universitätsklinikum Essen
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: For selected individuals with chronic intractable headache disorders neuromodulative procedures have shown to be effective in reducing of pain intensity, frequency of attacks and / or headache days, and a reduction of days with attack aborting medication. We present a consecutive cohort of 44 patients with different intractable headache disorders that were subjected to occipital nerve stimulation (ONS) or sphenopalatine ganglion stimulation (SPGs).
Method: Between December 2008 and October 2013 a total of 44 patients were treated with implanted neuromodulation devices for their chronic headache disorders. There were 41 chronic cluster headaches (CCH), 3 chronic migraineurs (CM), and 2 occipital neuralgias (OcN). Patients received either subcutaneous electrodes for ONS or a retromaxillar placed electrode stimulating the sphenopalatine ganglion (SPGs). Medical records and patients' last follow-up were analysed with respect to response to treatment, complications, and outcome.
Results: ONS was conducted in 35 patients (30 CCH, 3 CM, 2 OcN) with a response rate of 86.7% (defined as a decrease of 50% from baseline in pain intensity, and / or attack frequency, and / or headache days). Complications occurred in 16 patients (45.7%), leading to reoperation in 15 patients (42,8%). In 9 patients (all CCH) SPGs was carried out with a response rate of 84% (according to afore mentioned). Complications occurred in 4 patients (44%), leading to reoperation in 3 patients (33%) (1 misplacement, 1 intractable nerve irritation, 1 insufficient power coupling). No infections were observed in SPG.
Conclusions: ONS and SPG, both have beneficial potentials for patients with chronic intractable headache disorders. Yet, both come along with a significant complication rate that is equally distributed in both procedures, a fact that has to be discussed with the patient prior to implantation. Nevertheless, for patients with otherwise refractory headaches stimulation of the occipital nerve or the sphenopalatine ganglion remains a forlorn hope of relieving their pain.
