Cluster headache attack remission with sphenopalatine ganglion stimulation: experiences in chronic cluster headache patients through 24 monthsReportar como inadecuado

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The Journal of Headache and Pain

, 17:67

Cluster Headache and other rare headaches


BackgroundCluster headache CH is a debilitating headache disorder with severe consequences for patient quality of life. On-demand neuromodulation targeting the sphenopalatine ganglion SPG is effective in treating the acute pain and a subgroup of patients experience a decreased frequency of CH attacks.

MethodsWe monitored self-reported attack frequency, headache disability, and medication intake in 33 patients with medically refractory, chronic CH CCH in an open label follow-up study of the original Pathway CH-1 study. Patients were followed for at least 24 months average 750 ± 34 days, range 699-847 after insertion of an SPG microstimulator. Remission periods attack-free periods exceeding one month, per the ICHD 3 beta definition occurring during the 24-month study period were characterized. Attack frequency, acute effectiveness, medication usage, and questionnaire data were collected at regular clinic visits. The time point -after remission- was defined as the first visit after the end of the remission period.

ResultsThirty percent 10-33 of enrolled patients experienced at least one period of complete attack remission. All remission periods followed the start of SPG stimulation, with the first period beginning 134 ± 86 range 21-272 days after initiation of stimulation. On average, each patient’s longest remission period lasted 149 ± 97 range 62-322 days. The ability to treat acute attacks before and after remission was similar 37 % ± 25 % before, 49 % ± 32 % after; p = 0.2188. Post-remission headache disability HIT-6 was significantly improved versus baseline 67.7 ± 6.0 before, 55.2 ± 11.4 after; p = 0.0118. Six of the 10 remission patients experienced clinical improvements in their preventive medication use. At 24 months post insertion headache disability improvements remained and patient satisfaction measures were positive in 100 % 10-10.

ConclusionsIn this population of 33 refractory CCH patients, in addition to providing the ability to treat acute attacks, neuromodulation of the SPG induced periods of remission from cluster attacks in a subset of these. Some patients experiencing remission were also able to reduce or stop their preventive medication and remissions were accompanied by an improvement in headache disability.

KeywordsCluster headache Remission Neuromodulation Neurostimulation Sphenopalatine ganglion  Download fulltext PDF

Autor: Mads C. J. Barloese - Tim P. Jürgens - Arne May - Jose Miguel Lainez - Jean Schoenen - Charly Gaul - Amy M. Goodman - A


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