Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Neuromodulation. 2019 Jul;22(5):638-644. doi: 10.1111/ner.12977. Epub 2019 Jun 14.
Occipital nerve stimulation (ONS) is widely used for headache syndromes including chronic migraine (CM) and chronic cluster headache (CCH). The paraesthesia associated with tonic stimulation can be bothersome and can limit therapy. It is now clear in spinal cord stimulation that paraesthesia-free waveforms can produce effective analgesia, but this has not been reported in ONS for CM or CCH.
Seventeen patients (12 CM and 5 CCH) were treated with bilateral burst pattern ONS, including 4 who had previously had tonic ONS. Results were assessed in terms of the frequency of headaches (number of headache days per month for CM, and number of attacks per day for CCH) and their intensity on the numeric pain rating scale.
Burst ONS produced a statistically significant mean reduction of 10.2 headache days per month in CM. In CCH, there were significant mean reductions in headache frequency (92%) and intensity (42%).
Paraesthesia is not necessary for good quality analgesia in ONS. Larger studies will be required to determine whether the efficacies of the two stimulation modes differ. Burst ONS is imperceptible and therefore potentially amenable to robustly blinded clinical trials.
枕神经刺激（ONS）广泛用于头痛综合征，包括慢性偏头痛（CM）和慢性丛集性头痛（CCH）。强直刺激相关的感觉异常可能会引起不适，并限制治疗。脊髓刺激中现在已经清楚，无感觉异常的波形可以产生有效的镇痛效果，但这在 CM 或 CCH 的 ONS 中尚未报道。
17 名患者（12 名 CM 和 5 名 CCH）接受了双侧爆发模式 ONS 治疗，其中 4 名患者之前接受过强直 ONS。通过每月头痛的频率（CM 的头痛天数，CCH 的每日发作次数）和数字疼痛评分量表上的强度来评估结果。
爆发 ONS 使 CM 每月的头痛天数平均减少 10.2 天。在 CCH 中，头痛频率（92%）和强度（42%）均有显著平均降低。
在 ONS 中，感觉异常对于良好的镇痛质量不是必需的。需要更大的研究来确定两种刺激模式的疗效是否存在差异。爆发 ONS 是不可感知的，因此可能适合进行稳健的盲法临床试验。
