New Treatment for Cluster Headaches
Nerve Stimulation Shows Promise When Drugs Fail
March 8, 2007 -- There is new hope for sufferers of an excruciatingly
painful type of headache who get no relief from drugs.
Two newly published studies show a minimally invasive nerve stimulation
procedure to be a safe and effective alternative to surgery for many patients
with drug-resistant cluster headaches.
The pain associated with cluster headaches is considered to be among the
worst that a human can experience. Sufferers often report relentless, intense
burning or stabbing pain located behind one eye, generally lasting from 30
minutes to 90 minutes and recurring several times a day.
About one in 1,000 people get cluster headaches, making them far less common
than migraines and other types of headaches. And unlike migraines, men get them
more often than women.
“The only suicides I have ever seen due to headaches are in people who get
cluster headaches. That is how painful they are,” National Headache Foundation
executive chairman Seymour Diamond, MD, tells WebMD. “That is why some people
call them ‘the suicide headache.’”
Drugs Help Most Patients
Most cluster headache sufferers respond to drug treatments designed to
prevent attacks or minimize their intensity. But the options for those who
don’t respond are few, and those options are associated with troubling and even
potentially life-threatening side effects, says neurologist Peter J. Goadsby,
MD, PhD, of the U.K. Institute of Neurology.
Patients who are not helped with less-invasive treatments may opt for
surgery to destroy nerves in the brain that carry pain signals to the face. The
surgery is permanent, and it doesn’t always work, Goadsby tells WebMD.
“We really need to do better by these patients,” he says. “There is no place
in modern headache treatment for destructive procedures like these.”
Goadsby decided to try a technique known as occipital nerve stimulation
after seeing how well the therapy worked in other hard-to-treat head pain
Eight patients with chronic cluster headaches who got little relief from
drug treatments were recruited for the trial.
The procedure involves positioning a fine electrode under the skin at the
base of the skull. This is attached to a wire leading to a pacemaker-like
device implanted elsewhere in the body. An external generator controls the
degree of stimulation the patients receive.
The trial participants were followed for an average of 20 months, during
which time two patients reported 90% to 95% improvements in attacks. Four other
patients reported more moderate improvements of between 20% and 80%.
Six of the eight patients said they would recommend the treatment to other
people with drug-resistant chronic cluster headaches.
In a similarly designed study from Belgium’s Liege University, two of eight
patients treated with occipital nerve stimulation reported being pain-free
after follow-ups of 16 and 22 months, respectively. Three other patients
reported roughly 90% reductions in headache frequency and only one patient
The studies are published in the March 8 online editions of the journals
The Lancet and The Lancet Neurology.