Occipital Nerve Stimulation in Highly Refractory Chronic Headaches: Identification of Possible Predictors of Success

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SCIENCE
Occipital Nerve Stimulation in Highly Refractory Chronic Headaches: Identification of Possible Predictors of Success
Key Take-Away: 

Occipital nerve stimulation is emerging as a promising therapy for patients with intractable and highly disabling chronic headache disorders. It is a relatively a safe procedure with no serious adverse event. This study has put light on the effectiveness of occipital nerve stimulation which may improve chronic headaches.

Occipital nerve stimulation (ONS) appears a promising treatment for refractory headaches. 

ABSTRACT: 
Background: 

Occipital nerve stimulation (ONS) appears a promising treatment for refractory headaches. The procedure is invasive and response rates vary between studies. Identification of clinical predictors of outcome is therefore of importance.

Methods: 

A total of 165 patients undergoing ONS at a single centre were studied. Headache load was calculated at baseline and final follow-up. A positive response was defined as a 30% reduction in headache load. A multivariate logistic regression analysis was carried out to identify predictors of outcome.

Results: 

Patient group was highly refractory at baseline. At a mean follow up of 40 months the response rate of the group was 50%. Clinical factors identified with an increased likelihood of response were co-existent chronic migraine and chronic cluster and the presence of non-headache related pain disorders. Occipital pain was associated with a reduced likelihood of response. Adverse event rates were favourable.

Conclusion: 

ONS is a potentially useful and safe treatment in refractory chronic headache disorders. The presence of multiple pain syndromes appears associated with increased likelihood of response and presence of occipital pain with a reduced likelihood.

J Neurol Neurosurg Psychiatry 2015;86:e4

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