Burns Brian, Watkins Laurence, Goadsby Peter J
Headache Group, Department of Neurology, University of California San Francisco, San Francisco, CA 19143-0114, USA.
Neurology. 2009 Jan 27;72(4):341-5. doi: 10.1212/01.wnl.0000341279.17344.c9.
Cluster headache is a primary headache involving repeated attacks of excruciatingly severe headache usually occurring several times a day. Most patients with chronic cluster headache (CCH) have an unremitting illness requiring daily preventive therapy for years.
To describe the clinical outcome of occipital nerve stimulation (ONS) for 14 patients with intractable CCH.
Fourteen patients with medically intractable CCH were implanted with bilateral electrodes in the suboccipital region for ONS and a retrospective assessment of their clinical outcome obtained.
At a median follow-up of 17.5 months (range 4-35 months), 10 of 14 patients reported improvement and 9 of these recommend ONS. Three patients noticed a marked improvement of 90% or better (90%, 90%, and 95%), 3 a moderate improvement of 40% or better (40%, 50%, and 60%), and 4 a mild improvement of 20-30% (20%, 20%, 25%, and 30%). Improvement occurred within days to weeks for those who responded most and patients consistently reported their attacks returned within hours to days when the device was off. One patient found that ONS helped abort acute attacks. Adverse events of concern were lead migrations and battery depletion.
Intractable chronic cluster headache (CCH) is a devastating, disabling condition that has traditionally been treated with cranially invasive or neurally destructive procedures. ONS offers a safe, effective option for some patients with CCH. More work is required to evaluate and understand this novel therapy.
丛集性头痛是一种原发性头痛，表现为反复出现的极其严重的头痛发作，通常一天发作数次。大多数慢性丛集性头痛（CCH）患者病情持续，需要数年进行每日预防性治疗。
描述14例顽固性CCH患者接受枕神经刺激（ONS）的临床结果。
对14例药物治疗无效的CCH患者在枕下区域植入双侧电极进行ONS，并对其临床结果进行回顾性评估。
中位随访17.5个月（范围4 - 35个月），14例患者中有10例报告有改善，其中9例推荐ONS。3例患者有90%或更好的显著改善（90%、90%和95%），3例有40%或更好的中度改善（40%、50%和60%），4例有20% - 30%的轻度改善（20%、20%、25%和30%）。反应最快的患者在数天至数周内出现改善，且患者一致报告当设备关闭时，发作会在数小时至数天内再次出现。1例患者发现ONS有助于中止急性发作。值得关注的不良事件是导线移位和电池耗尽。
顽固性慢性丛集性头痛（CCH）是一种破坏性、致残性疾病，传统上采用侵入性颅骨手术或神经破坏性手术治疗。ONS为一些CCH患者提供了一种安全、有效的选择。需要更多工作来评估和理解这种新疗法。
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