To provide long-term data on clinically meaningful pain alleviation in drug-refractory headache disorders with occipital and supraorbital nerve stimulation (ONS; SONS).
Retrospective review of 96 patients suffering from migraine, cervicogenic headache, cluster headache, neuropathic pain of the scalp, tension-type headache and new daily persistent headache, who underwent ONS (61.5%), SONS (11.5%), or a combined ONS + SONS (27.1%) trial implantation and definitive implantation between 2007 and 2017. Changes in pain perception over time were followed using the visual analog scale (VAS).
The cohort consisted of 60.4% females and 39.6% males with a mean age of 46.9±11.5 years and pain duration of 14±14.1 years. 65 (67.7%) were treatment-responders to a trial (at least 30% amelioration of average or maximum VAS pain and/or number of headache days) lasting 22.5±8.8 days, with a reduction of their average VAS pain to 37±24.4% of baseline (vs. 99.1±24.1% of baseline for non-responders; p<0.01). Out of 56 implanted patients with long-term follow-up of up to 10 years, 32 (57.1%) reported a ≥50% reduction of their average VAS pain. Four patients (6.5%) requested hardware explantation. Stage II complications included 1 infection (1.6%) and 6 electrode dislocations (9.7%). Study limitations included the retrospective nature, lack of controls receiving placebo intervention and as such randomization.
After careful patient selection, based on a positive response to a trial of ONS / SONS, clinically meaningful long-term benefit can be achieved in 57.1% of the patients with various chronic headache conditions.

Copyright © 2021 Elsevier Inc. All rights reserved.