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Published on: May 10, 2017
High Cervical 10 kHz Spinal Cord Stimulation After Occipital Nerve Stimulation Failure in Medically Intractable
Casper S Lansbergen1, Anne W Veenhuizen2, Rolf Fronczek3
1Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Objectives:
In this retrospective study, we evaluated high-frequency spinal cord stimulation (SCS) as an alternative neuromodulation strategy for patients with medically intractable chronic cluster headache (MICCH) in whom occipital nerve stimulation (ONS) had failed.
Background:
MICCH represents a severe and treatment-resistant form of cluster headache, for which preventive pharmacologic treatment options are limited. ONS is increasingly used as a peripheral neuromodulation strategy for MICCH, but a subset of patients remains refractory despite treatment. Cervical SCS could be a central neuromodulation strategy for these patients.
Materials And Methods:
This retrospective study included 14 patients with MICCH (nine female, five male; mean age 47 years) who were treated with high cervical 10 kHz SCS after ONS failure. Clinical data were collected on attack frequency, attack duration, intensity of attacks, and quality of life throughout the duration of neuromodulation treatment.
Results:
Mean SCS follow up duration is 33 ± 21 months. At the last SCS follow-up, ten of 14 patients had a lower mean attack frequency compared with their last ONS assessment (64 ± 33 vs 36 ± 34 weekly attacks, p = 0.02). At the last SCS follow-up six patients obtained a reduction in attack frequency relative to baseline. Mean attack duration decreased from 110 ± 86 to 88 ± 56 minutes, whereas attack intensity remained unchanged. Quality-of-life outcomes were inconsistent and did not uniformly correspond with clinical improvement.
Conclusions:
High cervical 10 kHz SCS may represent a feasible rescue neuromodulation strategy for patients with MICCH unresponsive to ONS, with a subset achieving sustained reductions in attack frequency. Interpretation of the effects of SCS on attack duration and pain intensity is limited due to missing data. Nevertheless, these findings support its potential as a treatment option in this highly resistant population. Well-controlled prospective studies are needed to confirm efficacy and further define the role of SCS in treatment algorithms.
Clinical Trial Registration:
This study was not registered as a clinical trial it is a retrospective observational cohort study. The intervention was offered as a last-resort treatment within regular clinical care to patients with medically intractable chronic cluster headache and was therefore not prospectively designed or conducted as a trial.
