Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study: Rationale and protocol of a randomised trial

Wilbrink, Leopoldine A.; Teernstra, Onno P.M.; Haan, Joost; Zwet, Erik W. van; Evers, Silvia M. A. A.; Spincemaille, G.H.; Veltink, Petrus H.; Mulleners, Wim M.; Brand, Ronald; Huygen, Frank; Jensen, Rigmor Højland; Paemeleire, Koen; Goadsby, Peter J.; Visser‐Vandewalle, Veerle; Ferrari, Michel D.

doi:10.1177/0333102413490351

Cited by 71 publications

(53 citation statements)

References 39 publications

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“…The first shamcontrolled trial (ICON) is still ongoing (57). In one trial, eight iCCH patients were implanted bilaterally: six patients reported 20-95% ameliorations of attack frequency and intensity after a follow-up of 6-27 months (49).…”

Section: Cluster Headachementioning

confidence: 99%

Invasive pericranial nerve interventions

Ambrosini

Schoenen

2016

Cephalalgia

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Background In many patients suffering from primary headaches, the available pharmacological and behavioural treatments are not satisfactory. This is a review of (minimally) invasive interventions targeting pericranial nerves that could be effective in refractory patients. Methods The interventions we will cover have in common pericranial nerves as targets, but are distinct according to their rationale, modality and invasiveness. They range from nerve blocks/infiltrations to the percutaneous implantation of neurostimulators and surgical decompression procedures. We have critically analysed the published data (PubMed) on their effectiveness and tolerability. Results and conclusions There is clear evidence for a preventative effect of suboccipital injections of local anaesthetics and/or steroids in cluster headache, while evidence for such an effect is weak in migraine. Percutaneous occipital nerve stimulation (ONS) provides significant long-term relief in more than half of drug-resistant chronic cluster headache patients, but no sham-controlled trial has tested this. The evidence that ONS has lasting beneficial effects in chronic migraine is at best equivocal. Suboccipital infiltrations are quasi-devoid of side effects, while ONS is endowed with numerous, though reversible, adverse events. Claims that surgical decompression of multiple pericranial nerves is effective in migraine are not substantiated by large, rigorous, randomized and sham-controlled trials.

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Section: Cluster Headachementioning

confidence: 99%

Invasive pericranial nerve interventions

Ambrosini

Schoenen

2016

Cephalalgia

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“…Really these procedures have been utilized worldwide by different surgeons and their efficacy has been confirmed by multicentric studies [18] and large series by single qualified authors [19][20][21].…”

Section: Discussionmentioning

confidence: 97%

Surgery for treatment of refractory chronic cluster headache: toward standard procedures

Franzini

Messina

2015

Neurol Sci

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The degree of disability due to chronic cluster headache refractory to conservative treatments justifies surgical procedures as second-line treatments. Many studies and reports nowadays confirm the efficacy of the two mostly used surgical techniques in such cases. Both deep brain stimulation and occipital nerve stimulation are in fact currently utilized for this purpose but the surgical technique has not yet been standardized. We describe the surgical steps of both procedures.

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“…ONS has been used to treat occipital neuralgia, [168][169][170][171] chronic migraine, 172,173 hemicrania continua, 174 SUNCT, 175 and cluster headache. 174,[176][177][178][179] A recent systematic review concluded that there is at least level IV (limited) evidence supporting the use of ONS. 180 Given the consistently positive outcomes found in well-designed studies, the authors recommended that ONS be offered to patients with frequent, severe, and disabling chronic headaches who have failed reasonable conservative management and interventional pain medicine efforts.…”

Section: Neuromodulation Techniquesmentioning

confidence: 99%