Resident Physician University of Calgary Calgary, Alberta, Canada
Introduction: Trigeminal autonomic cephalalgias (TACs) are a group of highly disabling primary headache disorders. While various pharmacologic therapeutic options exist, they are not always effective or well tolerated. Occipital nerve stimulation (ONS) is a potentially effective surgical treatment. However, there is no data collectively evaluating ONS as a treatment for all TACs. Our main objective was to perform a systematic review of the efficacy of ONS in treating TACs.
Methods: A systematic review was performed using Medline, Embase and Cochrane databases. Study quality was assessed using the NIH Study Quality Assessment tool. Primary outcomes were reduction in headache intensity, duration, and frequency. Secondary outcomes included adverse event rate and reduction in medication use. Because of large differences in outcome measures compared to other TACs, data for patients suffering from short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting, unilateral, neuralgiform headache attacks with cranial autonomic symptoms (SUNA) were reported separately.
Results: A total of 417 patients were included in the analysis, of which 15 patients were in the SUNCT/SUNA cohort. For the 402 non-SUNCT/SUNA patients, mean length of follow-up time was 45 months (range 12-120). The mean reduction in headache intensity and duration were 26.2% and 31.4%, respectively. There was a mean reduction in headache frequency of 50%, as well as a 61.2% reduction in use of abortive medications and a 31.1% reduction in the use of prophylactic medications. In the SUNCT/SUNA cohort, the mean decrease in headache intensity and duration were 56.8% and 42.8%, respectively. The overall responder rate, defined as a >50% reduction in attack frequency, was 60.8% for the non-SUNCT/non-SUNA cohort and 66.7% for the SUNCT/SUNA cohort. Adverse events requiring repeat surgery were reported in 33% of cases.
Conclusion : ONS may be an effective surgical treatment for approximately two-thirds of patients with medically refractory TACs.
