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.
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.
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