Occipital nerve stimulation is an effective treatment option for chronic headache and leads to a better response rate in short-lasting unilateral neuralgiform headaches compared with chronic migraine, according to findings from an open-label prospective study published in Cephalalgia.

Investigators examined 100 patients undergoing occipital nerve stimulation to determine response predictors in migraine and/or headache attacks. A total of 35 patients had chronic migraine, 20 had short-lasting unilateral neuralgiform headache attacks, 33 had chronic cluster headache, and 12 had hemicrania continua.

The overall response rate of the cohort was 48%. Following multivariate analysis, researchers found that there was a greater chance for therapy response among patients with short-lasting unilateral neuralgiform headache attacks (odds ratio, [OR] 6.71; 95% CI, 1.49-30.05; P =.013) as well as among patients with a previous response to greater occipital nerve block (OR 4.22; 95% CI, 1.35-13.21; P =.013), compared with other patients in the cohort.


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In addition, mood disorders such as anxiety and depression and the presence of occipital pain during implantation were found to correlate with a reduced chance for response to therapy (OR 0.32; 95% CI, 0.11-0.91; P =.032), potentially resulting in poor outcomes for this patient population.

The main limitation to this study was its prospective nature and lack of a placebo control. Despite this weakness, the investigators commented, “Occipital nerve stimulation appears to be a useful treatment for some intractable primary headache conditions where other treatments have failed,” concluded the researchers.

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Reference

Miller S, Watkins L, Matharu M. Predictors of response to occipital nerve stimulation in refractory chronic headache [published online January 1, 2017]. Cephalalgia. doi: 10.1177/0333102417728747