Abstract
BackgroundA retrospective review of patients treated with Occipital Nerve Stimulation (ONS) at two large tertiary referral centres has been audited in order to optimise future treatment pathways.MethodsPatient’s medical records were retrospectively reviewed, and each patient was contacted by a trained headache expert to confirm clinical diagnosis and system efficacy. Results were compared to reported outcomes in current literature on ONS for primary headaches.ResultsTwenty-five patients underwent a trial of ONS between January 2007 and December 2012, and 23 patients went on to have permanent implantation of ONS. All 23 patients reached one-year follow/up, and 14 of them (61%) exceeded two years of follow-up. Seventeen of the 23 had refractory chronic migraine (rCM), and 3 refractory occipital neuralgia (ON). 11 of the 19 rCM patients had been referred with an incorrect headache diagnosis. Nine of the rCM patients (53%) reported 50% or more reduction in headache pain intensity and or frequency at long term follow-up (11–77 months). All 3 ON patients reported more than 50% reduction in pain intensity and/or frequency at 28–31 months. Ten (43%) subjects underwent surgical revision after an average of 11 ± 7 months from permanent implantation - in 90% of cases due to lead problems. Seven patients attended a specifically designed, multi-disciplinary, two-week pre-implant programme and showed improved scores across all measured psychological and functional parameters independent of response to subsequent ONS.ConclusionsOur retrospective review: 1) confirms the long-term ONS success rate in refractory chronic headaches, consistent with previously published studies; 2) suggests that some headaches types may respond better to ONS than others (ON vs CM); 3) calls into question the role of trial stimulation in ONS; 4) confirms the high rate of complications related to the equipment not originally designed for ONS; 5) emphasises the need for specialist multidisciplinary care in these patients.
Highlights
A retrospective review of patients treated with Occipital Nerve Stimulation (ONS) at two large tertiary referral centres has been audited in order to optimise future treatment pathways
Chronic migraine (CM), the most prevalent form of Chronic Daily Headache (CDH), is defined as headache occurring more than 15 days/ month for at least 3 consecutive months, with headache having the clinical features of migraine without aura for at least 8 days per month [4]
Twenty-five patients underwent a trial of ONS between January 2007 and December 2012 (Male/Female: 7/18; Average age: 49 ± 14 years) (Table 1)
Summary
A retrospective review of patients treated with Occipital Nerve Stimulation (ONS) at two large tertiary referral centres has been audited in order to optimise future treatment pathways. Chronic Daily Headache (CDH) is an umbrella term for headache disorders with a high rate of reoccurrence (15 or more days per month for 3 consecutive months). CDH represents a major worldwide health problem as affects 3–5% of adults [1,2,3] who experience substantial disability. Chronic migraine (CM), the most prevalent form of CDH, is defined as headache occurring more than 15 days/ month for at least 3 consecutive months, with headache having the clinical features of migraine without aura for at least 8 days per month [4]. The World Health Organization recognizes migraine as a major public health problem, ranking it at 7th place among all worldwide diseases leading to disability [6]. CM is associated with higher disability, inferior quality of life and greater health resource utilization [7]
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