New Treatment for Cluster Headaches

Nerve Stimulation Shows Promise When Drugs Fail

Medically Reviewed by Louise Chang, MD on March 08, 2007
From the WebMD Archives

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.”

New Hope

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 patients.

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 discontinued treatment.

The studies are published in the March 8 online editions of the journals The Lancet and The Lancet Neurology.

Not Sure Why It Works

Neurologist Jean Schoenen, MD, PhD, who co-authored the Belgian study, tells WebMD that the next step is to figure out why the stimulation treatment works.

“We really don’t know,” he says. “We are hoping that brain imaging studies can tell us which areas of the brain are affected by this treatment.”

Diamond, who is founder and director of the Diamond Headache Clinic in Chicago, says he would consider trying the nerve stimulation procedure in his patients with drug-resistant chronic cluster headaches.

But he dismissed the idea that it is the only minimally invasive treatment option for these patients. He tells WebMD that he has had good responses with another minimally invasive treatment.

“The main message is that there are effective treatments for the vast majority of cluster headache patients,” he says.

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SOURCES: Burns, B. The Lancet, March 8, 2007; online edition. Magis, D. The Lancet Neurology, March 8, 2007; online edition. Peter J. Goadsby, MD, PhD, professor of neurology, U.K. Institute of Neurology, University College London. Jean Schoenen, MD, PhD, headache research unit, department of neurology, Liege University, Liege, Belgium. Seymour Diamond, MD, executive chairman, National Headache Foundation; founder and director, Diamond Headache Clinic, Chicago.

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