Mercieri Marco, Leoni Matteo Luigi Giuseppe, Naccarato Alessia, Viswanath Omar, Sarmi Samah Said Al, Varrassi Giustino, Cascella Marco, Arcioni Roberto
Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy.
Unit of Anesthesia, Intensive Care and Pain Management, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy.
Curr Pain Headache Rep. 2025 May 26;29(1):90. doi: 10.1007/s11916-025-01401-3.
Refractory chronic migraine (rCM) is characterized by debilitating headaches that do not respond adequately to conventional medical treatments, leaving patients severely disabled. In these rare cases, central cervical spinal cord stimulation or occipital nerve stimulation (ONS) may offer a potential therapeutic option. However, these techniques are not without risks, lack clear scientific evidence, and impose a significant economic burden. Therefore, it is crucial to identify parameters that can assist physicians in selecting appropriate candidates for implantation. This study aimed to investigate the role of psychological profiles in predicting outcomes for ONS in rCM patients.
We conducted a retrospective analysis on rCM patients treated with ONS at a second-level neuromodulation university facility. These patients were refractory to conventional medical treatments, including onabotulinumtoxin-A injections (monoclonal antibodies targeting CGRP were not yet available). The NRS for migraine intensity, the number of monthly migraine attacks, and drug consumption were assessed at 6-month and 12-month follow-ups post-implant. Psychological profiles were evaluated prior to OCN using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). A multivariable logistic regression model was developed to predict ONS outcomes, incorporating MMPI-2 as a covariate. The model's accuracy and performance were assessed through non-parametric bootstrap, calibration, and discrimination analyses.
Twenty-three rCM patients were analysed. ONS was able to significantly reduce the pain intensity, the number of headache attacks per month, and drug consumption compared to pre-treatment levels at both 6- and 12-month follow-ups. The final multivariable logistic model at 12 months showed that the MMPI-2 Depression score was independently and negatively associated with favourable outcomes following ONS (optimism-adjusted OR 0.52, 95% CI 0.21-0.77, p = 0.03). The ROC curve indicated high model sensitivity (AUC: 0.96, 95% CI: 0.88-0.98), and the calibration plot revealed a good fit, with some improvement needed in mid-range predicted probabilities.
ONS significantly reduced pain intensity, headache frequency, and drug use at the 12-month follow-up compared to pre-treatment levels. The MMPI-2 Depression score was an independent predictor of ONS failure, highlighting the importance of comprehensive psychological assessments in patient selection for ONS.
难治性慢性偏头痛（rCM）的特点是头痛使人衰弱，对传统医学治疗反应不佳，导致患者严重残疾。在这些罕见病例中，颈髓中央刺激或枕神经刺激（ONS）可能提供一种潜在的治疗选择。然而，这些技术并非没有风险，缺乏明确的科学证据，且带来巨大经济负担。因此，确定能够帮助医生选择合适植入对象的参数至关重要。本研究旨在调查心理特征在预测rCM患者ONS治疗结果中的作用。
我们对在一所二级神经调节大学机构接受ONS治疗的rCM患者进行了回顾性分析。这些患者对包括注射A型肉毒毒素（当时尚无靶向降钙素基因相关肽的单克隆抗体）在内的传统医学治疗均无效。在植入后6个月和12个月的随访中评估偏头痛强度的数字评分量表（NRS）、每月偏头痛发作次数和药物消耗量。在进行ONS之前，使用明尼苏达多相人格调查表-2（MMPI-2）评估心理特征。建立了一个多变量逻辑回归模型来预测ONS结果，将MMPI-2作为一个协变量纳入其中。通过非参数自助法、校准和鉴别分析评估模型的准确性和性能。
分析了23例rCM患者。与治疗前水平相比，在6个月和12个月的随访中，ONS均能显著降低疼痛强度、每月头痛发作次数和药物消耗量。12个月时的最终多变量逻辑模型显示，MMPI-2抑郁评分与ONS后的良好结果独立且呈负相关（乐观调整后的比值比为0.52，95%置信区间为0.21-0.77，p = 0.03）。ROC曲线显示模型敏感性较高（曲线下面积：0.96，95%置信区间：0.88-0.98），校准图显示拟合良好，但在中等范围的预测概率方面仍需改进。
与治疗前水平相比，在12个月的随访中，ONS显著降低了疼痛强度、头痛频率和药物使用量。MMPI-2抑郁评分是ONS失败的独立预测因素，突出了在选择ONS患者时进行全面心理评估的重要性。
