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Stymulacja nerwów obwodowych w migrenie

Nerve Stimulation Therapy Alleviates Pain For Chronic Headache

The Lancet, November 2008: A novel therapy using a miniature nerve stimulator instead of medication for the treatment of profoundly disabling headache disorders improved the experience of pain by 80-95 percent, according to a new study from the University of California, San Francisco and the Institute of Neurology at the National Hospital for Neurology and Neurosurgery, London .The study received external support from Boston Scientific Neuromodulation.

 

 

Treatment of hemicrania continua by occipital nerve stimulation with a bion device: long-term follow-up of a crossover study

Brian Burns MRCP a, Laurence Watkins FRCS b, Peter J Goadsby MD/ The Lancet Neurology, Volume 7, Issue 11, Pages 1001 - 1012, November 2008

From Editor

Hemicrania continua is a rare and poorly understood form of chronic headache. The disorder is responsive to indometacin, but patients for whom this drug is contraindicated or not tolerated have few treatment options. Stimulation of the greater occipital nerve has previously shown efficacy in chronic migraine and chronic cluster headache, and in three patients with hemicrania continua. In this study, the efficacy of stimulation of this nerve was tested in an additional six patients over several months, who used a smaller stimulation device than is commonly used for occipital nerve stimulation. The device was well tolerated, and five of the patients reported an improvement and would recommend the device to other patients with hemicrania continua.

Background

Hemicrania continua (HC) is a primary headache that comprises persistent unilateral pain, is associated with cranial autonomic features, and is responsive to indometacin. Some patients are unable to tolerate this treatment or it is contraindicated; for these patients, the medical options for therapy are restricted. Occipital nerve stimulation (ONS) is an effective treatment for medically intractable primary headache, but only three cases of HC treated with ONS have been reported. Here, we report long-term safety and efficacy data for ONS in six patients with HC. ONS was provided by a unilateral neurostimulation device, known as a bion, which might be described as a second-generation ONS device.

Methods

Six patients aged 18 years or older who were diagnosed with HC had a suboccipital bion device implanted ipsilateral to their headache and received continuous unilateral ONS. A crossover study design was used: the bion was on for the first 3 months, off for the fourth month, and on again during long-term follow-up. Detailed prospective headache diaries were kept for 1 month before implantation and for 5 months afterwards. Long-term data were obtained from patients' estimates of their outcome. The outcome of this study was assessed by a comparison of headache pain severity before and after ONS.

Findings

At a median follow-up of 13·5 months (range 6—21 months), five of six patients reported sufficient benefit to recommend the device to other patients with HC. At long-term follow-up, four of six patients reported a substantial improvement (80—95%), one patient reported a 30% improvement, and one patient reported that his pain was worse by 20%. The onset of the benefit of ONS was delayed by days to weeks, and headaches did not recur for a similar period when the device was switched off. Adverse events were mild and associated with transient overstimulation.

Interpretation

ONS appears to be a safe and effective treatment for HC, particularly when indometacin is not tolerated or is contraindicated. The bion device was well tolerated, easily inserted without significant morbidity, and is one-twentieth of the volume of current devices. Such miniaturised devices are a potential new option for treatment of HC.

Funding

Boston Scientific Neuromodulation.