Occipital Nerve Stimulation in Medically Refractory Chronic Cluster Headache
DOI:
https://doi.org/10.5281/zenodo.22310385Keywords:
Cluster headache, Occipital nerve stimulation, Neuromodulation, Refractory headache, Deep brain stimulationAbstract
Background: A meaningful minority of chronic cluster headache (CCH) patients become refractory to pharmacological
prophylaxis. Occipital nerve stimulation (ONS) has been used off-label for over two decades in this population.
Objective: To synthesise published evidence on ONS for medically refractory CCH against other neuromodulation approaches.
Methods: Narrative review of case series, randomised sham/placebo-controlled trials, comparator, and complication/durability
literature. Findings: Early case series reported roughly 50% responder rates with continuous ONS. The dose-controlled ICON trial found
high- and low-amplitude tonic ONS both reduced attack frequency by about 50% without separating from each other, with
benefit sustained over a 2-8-year extension. A newer placebo-controlled trial of paresthesia-free burst ONS, however, did not
outperform placebo. Sphenopalatine ganglion stimulation, vagus nerve stimulation and hypothalamic deep brain stimulation
show efficacy signals with differing risk profiles. Lead migration and infection are the dominant device-related complications.
Conclusions: ONS is a reasonably well-supported, comparatively low-risk option for refractory CCH, though blinded evidence
remains limited and stimulation-paradigm effects are unresolved.
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