gms | German Medical Science

Objective: Cluster headache (CH) is a rare entity of the trigeminal autonomic cephalgias, which remains difficult to treat. Neuromodulatory procedures such as bilateral greater occipital nerve stimulation (ONS), sphenopalatine ganglion stimulation (SPG) or spinal cord stimulation (SCS) represent promising surgical approaches. However, the use of percutaneous leads in the high cervical area during SCS often leads to dislocations due to the increased mobility and the small target region (C2/3). Surgical leads may offer advantages in this situation. In the literature only case reports or studies with low case numbers on SCS in CH exist so far. We report our results from 5 patients treated with SCS by percutaneous or surgical leads.

Methods: We treated 5 patients (5 males, median age 52 [31-56]) with drug-resistant CH using SCS (level C2/3; 4 percutaneous, 1 surgical lead) in our clinic between 07/2017 and 04/2019 after a successful test stimulation (50% reduction in attack frequency). A retrospective descriptive analysis was performed with pre- and postoperative assessment of the Brief Pain Inventory (BPI), Pain Disability Index (PDI), Pain Catastrophizing Scale (PCS), Beck Depression Inventory II (BDI-II), Short Form 36 (SF-36), Symptom Check List (SCL-90-R) and Cluster Headache Severity Scale (CHSS).

Results: CHSS improved from pre- to postoperative by median 5/12 [0-12]. The BPI [median improvement 41.7% [0-100]), PDI (median improvement PR 69 [1-81]), PCS (median improvement PR 81 [2-94]), BDI (median improvement 8/63 [0-31], SCL-90 [median improvement t-value GSI 5 [0-36]) and SF-36 (emotional well-being median improvement t-value 28 [48-100]) also showed improvements. Overall, 4 out of 5 patients showed improvement in all scores, 3 of them with clinical symptom clearance and one with slight symptom reduction. In one case, neither a clear change of the score results nor of the symptoms was achieved. Relevant side effects did not occur in any patient. One patient had to have a probe repositioned one month after implantation. Another patient with implanted and recurrently defective percutaneous leads was already revised four times ex domo before a surgical lead was inserted in domo. This was revised once in the case of a probe defect and the patient has been symptom-free since then.

Conclusion: Cluster headaches can be well treated with SCS as a neuromodulatory procedure. However, percutaneous leads showed a tendency to dislocation. In this case, surgical leads can offer a possible advantage.