Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
Department of Neurosurgery, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
Neuromodulation. 2021 Aug;24(6):1093-1099. doi: 10.1111/ner.13282. Epub 2020 Sep 30.
New daily persistent headache (NDPH) is a subset of chronic headache where the pain is continuous from onset. Phenotypically it has chronic migraine or chronic tension type features. NDPH is considered to be highly refractory. Occipital nerve stimulation (ONS) has been used for treatment of refractory chronic migraine but there are no specific reports of its use for NDPH with migrainous features.
Nine patients with NDPH with migrainous features were identified as having had ONS implants between 2007 and 2014 in a specialist unit with experience of using ONS in chronic migraine. Moderate to severe headache days were compared at baseline and follow-up. A positive response was defined as at least 30% reduction in monthly moderate to severe headache days.
Patients had suffered NDPH for a median of 8 years (range 3-16 years) and had failed a median of 11 previous treatments (range 8-15). After a median follow-up of 53 months (range 27-108 months), only a single patient showed a positive response to ONS. At no point did the cohort as a whole show any change in monthly moderate to severe headache days or disability scores.
Our experience suggests that ONS is not effective in the treatment of NDPH with migrainous features even in centers with experience in treating chronic migraine with ONS. The difference in response rates of chronic migraine and NDPH with migrainous features supports the concept of a different pathophysiology to the two conditions.
新发持续性每日头痛（NDPH）是慢性头痛的一个亚组，其疼痛从发病开始就持续存在。从表型上看，它具有慢性偏头痛或慢性紧张型头痛的特征。NDPH 被认为是高度难治的。枕神经刺激（ONS）已被用于治疗难治性慢性偏头痛，但尚无其用于偏头痛样特征的 NDPH 的具体报告。
在一个专门的单位中，有 9 名具有偏头痛样特征的 NDPH 患者在 2007 年至 2014 年间被确定为接受 ONS 植入治疗。在基线和随访时比较中度至重度头痛天数。阳性反应定义为每月中度至重度头痛天数减少至少 30%。
患者的 NDPH 中位数持续时间为 8 年（范围 3-16 年），中位数失败治疗 11 次（范围 8-15 次）。在中位数随访 53 个月（范围 27-108 个月）后，只有 1 名患者对 ONS 有阳性反应。在整个队列中，没有任何一个时间点显示每月中度至重度头痛天数或残疾评分有任何变化。
我们的经验表明，即使在使用 ONS 治疗慢性偏头痛经验丰富的中心，ONS 对偏头痛样特征的 NDPH 治疗也无效。慢性偏头痛和偏头痛样特征的 NDPH 的反应率差异支持这两种疾病的病理生理学不同的概念。
