Neurostimulation Effective in Refractory Cervicogenic Headaches

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Health-related quality of life was significantly improved for responders of the occipital nerve stimulation therapy.
Health-related quality of life was significantly improved for responders of the occipital nerve stimulation therapy.

Occipital nerve stimulation (ONS) is a potentially safe and effective management strategy for daily moderate to severe refractory cervicogenic headaches (CeHs), according to the findings from a study published in Neuromodulation.

In this retrospective chart review, investigators identified 16 patients with daily moderate to severe unilateral headaches during a median of 15 years. Due to the refractory nature of the patients' CeH, ONS was provided as a last resort treatment strategy. The primary outcome for this analysis was a 50% reduction in headache days per month, whereas secondary outcomes were changes in the hospital anxiety and depression scale (HADS) score, EuroQol Group Visual Analog Scale rating of health-related quality of life (EQ VAS), 6-item headache impact test (HIT-6) score, work status, and medication abuse.

A total of 11 patients (69%) met the primary outcome and were considered responders to ONS at 1-year follow-up. Health-related quality of life was significantly improved in responders, as determined by a 40-point increase in the EQ VAS (P =.0013). There was also a significant (17.5-point) decrease in median HIT-6 scores (P =.0005). An overall decrease in anxiety (P =.0391) and/or depression (P =.0156) scores was observed in 37.5% of patients.

At 3-year follow-up, 6 patients (37.5%) were considered responders to ONS. Of these, 5 patients were responders at 1-year follow-up, and 1 patient demonstrated a response to therapy at 3 years. Similar to the findings at 1 year, the responders in the 3-year follow-up group also experienced significant improvements in the EQ VAS score (median change: 25-point increase, P =.019) and HIT-6 score (median change: 7.5-point decrease, P =.0017) compared with values at baseline. In addition, anxiety and depression scores resolved in 22.5% and 33.9% of patients, respectively.

The findings are limited due to the study's case-series nature and its small sample size. Lack of a placebo group also limited the investigators' ability to determine superiority or inferiority of ONS to other management strategies.

Despite the positive findings, the investigators of this review note that the “discordance between the primary outcome and other more subjective outcomes reveals that improvement in headache frequency cannot be used alone to assess patient global improvement.”

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Eghtesadi M, Leroux E, Fournier-Gosselin M-P, et al. Neurostimulation for refractory cervicogenic headache: a three-year retrospective study [published online November 27, 2017]. Neuromodulation. doi:10.1111/ner.12730

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