Neurostimulation for Refractory Cervicogenic Headache: A Three‐Year Retrospective Study

摘要

Background Occipital nerve stimulation (ONS) has been used for the treatment of neuropathic pain conditions and could be a therapeutic approach for refractory cervicogenic headache (CeH). Aim The aim of this study is to assess the efficacy and safety of unilateral ONS in patients suffering from refractory CeH. Methods We conducted a retrospective chart review on patients implanted from 2011 to 2013 at CHUM. The primary outcome was a 50% reduction in headache days per month. Secondary outcomes included change in EuroQol Group Visual Analog Scale rating of health‐related quality of life (EQ VAS), six item headache impact test (HIT‐6) score, hospital anxiety and depression scale (HADS) score, work status, and medication overuse. Results Sixteen patients fulfilled the inclusion criteria; they had suffered from daily moderate to severe CeH for a median of 15 years. At one year follow‐up, 11 patients were responders (69%). There was a statistically significant improvement in the EQ VAS score (median change: 40 point increase, p ?=?0.0013) and HIT‐6 score (median change: 17.5 point decrease, p ?=?0.0005). Clinically significant anxiety and depression scores both resolved amongst 60% of patients. At three years, six patients were responders (37.5%). Out of the 11 responders at one‐year post implantation, five had remained headache responders (R–R) and one additional patient became a responder (NR–R). There was a statistically significant improvement in the EQ VAS score (median change: 15 point increase, p ?=?0.019) and HIT‐6 score (median change: 7.5 point decrease, p ?=?0.0017) compared with baseline. Clinically significant anxiety and depression scores both, respectively, resolved among 22.5% and 33.9% of patients. Five out of seven disabled patients were back to work. Conclusion ONS may be a safe and effective treatment modality for patients suffering from a refractory CeH. Further study may be warranted.