Estimulación del nervio occipital para la cefalea en racimos refractaria al tratamiento farmacológico / Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache

Objetivo. Evaluar la utilidad de la estimulación del nervio occipital en el tratamiento de la cefalea en racimos crónica refractaria al tratamiento farmacológico. Pacientes y métodos. Serie prospectiva de cuatro pacientes, tres varones y una mujer. La edad media es de 42 años. Hay historia de cefalea en racimos de entre 1 y 16 años, con mal control de las crisis mediante tratamiento farmacológico. En todos los casos se han colocado percutáneamente electrodos octopolares en ambas regiones occipitales. Se ha realizado un seguimiento de seis meses. Resultados. A los seis meses se obtuvo una reducción de la frecuencia de las crisis del 56% (rango: 25-95%), una disminución en la intensidad del 48,8% (rango: 20-60%) y una disminución de la duración de un 63,8% (rango: 0-88,8%), sin observarse empeoramiento ni progresión de la enfermedad en ningún caso. La mejoría en la calidad de vida respecto a la prequirúrgica fue de un 15,4% (rango: 6-31,5%) en el cuestionario de salud SF-36. Excepto en un caso, se objetivó una reducción significativa en la cantidad y la dosis de fármacos requeridos respecto al tratamiento prequirúrgico. No se han detectado complicaciones postoperatorias. Todos los pacientes aconsejarían el procedimiento como opción terapéutica. Conclusiones. La estimulación del nervio occipital puede ser una alternativa terapéutica segura y efectiva en el tratamiento de la cefalea en racimos crónica refractaria al tratamiento farmacológico. Sin embargo, son necesarios más estudios para valorar la efectividad de la técnica en un mayor número de pacientes y los resultados a largo plazo (AU)

Aim. To evaluate the occipital nerve stimulation therapy in as a treatment for drug-resistant cluster headache. Patients and methods. Prospective study of four patients, three males and one female. Mean age of 42 years. Patients complained of a cluster headache lasting between one and 16 years, with suboptimal control of the attacks with medication. In all cases octopolar electrodes were placed percutaneously in the occipital region bilaterally. Follow-up of 6 months. Results. At 6 months, there was a 56% (range: 25-95%) reduction in the frequency, a 48.8% (range: 20-60%) decrease in the intensity and a 63.8% (range: 0-88.8%) reduction in the duration of the attacks. Worsening or progression of the illness was not observed in any case. All patients referred a 15.4% (range: 6-31.5%) improvement in their quality of life compared to their previous basal situation in SF-36. In all cases but one there was a significant reduction in the amount and dosage of medication required. Postoperative complications were not observed. All patients would recommend the procedure. Conclusions. Occipital nerve stimulation may be considered a safe and effective therapeutic option in the drug-resistant cluster headache. However, studies with more patients and a longer follow-up are required to evaluate the efficacy of the technique (AU)

[Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache]. / Estimulación del nervio occipital para la cefalea en racimos refractaria al tratamiento farmacológico.

AIM: To evaluate the occipital nerve stimulation therapy in as a treatment for drug-resistant cluster headache. PATIENTS AND METHODS: Prospective study of four patients, three males and one female. Mean age of 42 years. Patients complained of a cluster headache lasting between one and 16 years, with suboptimal control of the attacks with medication. In all cases octopolar electrodes were placed percutaneously in the occipital region bilaterally. Follow-up of 6 months. RESULTS: At 6 months, there was a 56% (range: 25-95%) reduction in the frequency, a 48.8% (range: 20-60%) decrease in the intensity and a 63.8% (range: 0-88.8%) reduction in the duration of the attacks. Worsening or progression of the illness was not observed in any case. All patients referred a 15.4% (range: 6-31.5%) improvement in their quality of life compared to their previous basal situation in SF-36. In all cases but one there was a significant reduction in the amount and dosage of medication required. Postoperative complications were not observed. All patients would recommend the procedure. CONCLUSIONS: Occipital nerve stimulation may be considered a safe and effective therapeutic option in the drug-resistant cluster headache. However, studies with more patients and a longer follow-up are required to evaluate the efficacy of the technique.