Treatment of Medically Primary Intractable Chronic Headaches with Occipital Nerve Stimulation (ONS): The CHUV Experience

Aim: Medically intractable primary chronic headaches are disabling illnesses and their treatment is always challenging1. Occipital nerve stimulation (ONS) has been proposed since 1999 to treat some forms of primary chronic headache not responding to medical treatment, with good results2,3. However, few data are available in the literature and most of the published studies have a short follow-up. The aim of this study is to describe the clinical outcome of ONS in 7 patients treated in Lausanne.

Methods: Between September 2011 and January 2013, seven patients have been implanted in Lausanne with subcutaneously electrodes in the suboccipital region for medically intractable chronic headaches (3 for chronic migraines, 2 for cluster headaches, 2 for post-traumatic cervicogenic headaches). Data were prospectively collected preoperatively and at 3 and 12 months post-surgery. In the present study, VAS and headache attack frequency are evaluated.

Results: With an average follow-up of 15.2 months (range 3-28 months), 6/7 patients are satisfied about their stimulation and continue to use it. They had a global reduction of headache intensity of 28.5% at 3 months and 14.7% at 1 year and a cumulative decrease of headache attack frequency of 40.1% at 3 months and 31.5% at 1 year, even if we observed a great variability between patients. One patient with chronic migraine did not respond to ONS and was explanted. In the other 2 patients suffering from chronic migraine, a decrease of intensity and headache attacks was observed at 3 months and these values remained stable at 1 year. In the cluster headache subgroup, one patient had excellent results in terms of intensity and frequency decrease, but he was lost at follow-up 3 months after surgery. The second one had a good response at 3 months, but 1 year post surgery his pain started to recur. The subgroup of the 2 patients treated for post-traumatic cervicogenic headache seems to be the best responder, in particular in terms of reduction of attack frequency and stability of the effect. No adverse events were observed in our cohort.

Conclusions: Chronic headache is a disabling condition with important effects on everyday life in patients with medically intractable forms. The CHUV experience confirms that occipital nerve stimulation is an effective and safe option for selected patients with intractable chronic headaches. Further long-term controlled studies are required to strengthen the use of this technique.