Burns B et al. (2007) Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 369: 1099–1106

Cluster headache is a type of primary headache defined by bouts of very severe pain that occur several times daily. The chronic form of the condition can be medically intractable, forcing treating physicians to resort to invasive or neurally destructive surgical interventions that are associated with substantial morbidity. Peripheral stimulation of the occipital nerve has been successfully used in open-label trials to manage other forms of medically refractory headache.

Burns et al. investigated the use of bilateral occipital nerve stimulator implantation in a long-term, open-label study of eight patients with medically intractable chronic cluster headache (median age at surgery 46 years; median headache duration 6 years). Following implantation, six of the eight patients reported a meaningful improvement in the frequency or severity of their attacks after a median follow-up of 20 months (range 8–27 months) and stated that they would recommend the treatment to other similarly affected patients. The median level of improvement reported by these six patients was 60%; two reported an improvement of 90% or more, but none became pain free. Complications associated with the occipital nerve stimulator included battery failure (five incidents), electrode failure or migration (four incidents), muscle recruitment, neck spasms, and electric shock sensations. Headache attacks returned when technical problems halted the stimulation.

The authors concluded that occipital nerve stimulation is a safe and effective treatment for cluster headache, but further studies, with the addition of a placebo control, will be necessary to establish the optimum stimulation amplitude, frequency, and pulse width for maximum stimulation efficacy.