You’ve tried everything for your cluster headaches, and you've gotten no relief. Is it time to look into an experimental treatment called neurostimulation?
The basic idea is to use electricity to activate nerve cells, which alters your body’s pain signals, says Joel R. Saper, MD, founder and director of the Michigan Headache & Neurological Institute in Ann Arbor.
Some of the devices that do that are hand-held. For others, you have to get surgery to implant them, usually in your head.
For now, the only way to get neurostimulation for cluster headaches is to join a clinical trial.
Your doctor can help you find out about trials that are looking for people like you, and what the pros and cons are.
How It Works
Neurostimulation isn’t new. The FDA has approved it for conditions such as Parkinson’s and epilepsy. And now it’s getting attention as a potential treatment for cluster headaches.
At least four different approaches to neurostimulation are in development for this condition:
- The gammaCore doesn’t require surgery to implant it, but you'll need a doctor’s prescription if it’s approved. It’s about the size of your smartphone. You hold it up to your neck for 2 minutes at a time. It stimulates the vagus nerve in the neck and aims to prevent cluster headaches or to lessen the severity of one that’s already started. Potential side effects include temporary hoarseness and a tingling or prickling sensation during use.
- The ATI Neurostimulation System targets an area called the sphenopalatine ganglion (SPG), where “a whole bunch of nerve cells come together that stimulate various parts of the head, including the eyes and nasal passages,” Saper says. The device is smaller than an almond. A surgeon implants it through your mouth's upper gumline and guides it up into the area of your head where the SPG is.
- A third type of neurostimulation for cluster headaches focuses on the occipital nerves, which are in the back of the head.
- In deep brain neurostimulation, a surgeon places a device in your hypothalamus, which is a part of your brain behind your eyes. Unlike the other methods, this is major surgery.
How Well Does It Work?
Scientists are still studying that. The early research looks promising, but the studies have been small.
Trials of the gammaCore have included people who get both episodic cluster headaches and chronic cluster headaches (meaning their attacks are ongoing, without a break). One of the first studies was done in Europe, where the gammaCore has been on the market since 2011. It found that people with chronic cluster headaches who used the device had nearly four fewer headache attacks each week than people who didn’t use one. More trials are underway.
Saper is one of the researchers looking at whether SPG stimulation can help people with chronic cluster headaches who get at least four attacks per week.
In one study of 32 people, about two-thirds of those who were fitted with an SPG neurostimulator said they either had less pain during at least half of their attacks, had at least 50% fewer headaches, or both.
Scientists have also studied the approach that focuses on the occipital nerves. In one early, small study, eight people with chronic cluster headaches got this type of neurostimulation. At a follow-up 20 months later, two people said they had a “substantial” improvement in both the frequency and severity of their attacks, and three people described the improvement as “moderate.” Bigger studies are needed.
As for deep brain neurostimulation that targets the hypothalamus, researchers in Italy did a very small study about a decade ago to see if it could help with chronic cluster headaches. There were only five people in the study. Nearly 2 years after surgery, all of them said they no longer had headache pain, and two of them were able to stop taking medication. Larger studies are needed.