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Neuromodulation. 2018 Apr;21(3):302-309. doi: 10.1111/ner.12730. Epub 2017 Nov 27.

Neurostimulation for Refractory Cervicogenic Headache: A Three-Year Retrospective Study.

Author information

1
Department of Chronic Pain and Headache Management, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
2
Department of General Neurology and Headache Management, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
3
Department of Surgery, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
4
Department of Psychiatry, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
5
Department of General Neurology, Centre de Recherche du CHUM, Chronic Pain and Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
6
Department of Social and Preventative Medicine, School of Public Health, Centre de Recherche du CHUM, Montreal, Canada.
7
Centre de Recherche du CHUM, Faculty of Nursing, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
8
Department of Headache Management, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.

Abstract

BACKGROUND:

Occipital nerve stimulation (ONS) has been used for the treatment of neuropathic pain conditions and could be a therapeutic approach for refractory cervicogenic headache (CeH).

AIM:

The aim of this study is to assess the efficacy and safety of unilateral ONS in patients suffering from refractory CeH.

METHODS:

We conducted a retrospective chart review on patients implanted from 2011 to 2013 at CHUM. The primary outcome was a 50% reduction in headache days per month. Secondary outcomes included change in EuroQol Group Visual Analog Scale rating of health-related quality of life (EQ VAS), six item headache impact test (HIT-6) score, hospital anxiety and depression scale (HADS) score, work status, and medication overuse.

RESULTS:

Sixteen patients fulfilled the inclusion criteria; they had suffered from daily moderate to severe CeH for a median of 15 years. At one year follow-up, 11 patients were responders (69%). There was a statistically significant improvement in the EQ VAS score (median change: 40 point increase, p = 0.0013) and HIT-6 score (median change: 17.5 point decrease, p = 0.0005). Clinically significant anxiety and depression scores both resolved amongst 60% of patients. At three years, six patients were responders (37.5%). Out of the 11 responders at one-year post implantation, five had remained headache responders (R-R) and one additional patient became a responder (NR-R). There was a statistically significant improvement in the EQ VAS score (median change: 15 point increase, p = 0.019) and HIT-6 score (median change: 7.5 point decrease, p = 0.0017) compared with baseline. Clinically significant anxiety and depression scores both, respectively, resolved among 22.5% and 33.9% of patients. Five out of seven disabled patients were back to work.

CONCLUSION:

ONS may be a safe and effective treatment modality for patients suffering from a refractory CeH. Further study may be warranted.

KEYWORDS:

Cervical radiculopathy; cervicogenic; neurostimulation; occipital headache; post-traumatic

PMID:
29178511
DOI:
10.1111/ner.12730
[Indexed for MEDLINE]

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