Clinical predictors of therapeutic failure of occipital nerve stimulation in refractory chronic cluster headache.

Autor: Membrilla JA; Neurology Department, Hospital Universitari Francesc de Borja, Gandia, València, Spain., Cuadrado ML; Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.; Medicine Department, Universidad Complutense, Madrid, Spain., González-García N; Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain., Porta-Etessam J; Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.; Medicine Department, Universidad Complutense, Madrid, Spain., Sánchez-Soblechero A; Neurology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Lozano Ros A; Neurology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Gonzalez-Martinez A; Neurology Department, Hospital Universitario La Princesa, Madrid, Spain., Gago-Veiga AB; Neurology Department, Hospital Universitario La Princesa, Madrid, Spain., Quintas S; Neurology Department, Hospital Universitario La Princesa, Madrid, Spain., Rodríguez Vico JS; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Jaimes A; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Llorente Ayuso L; Neurology Department, Hospital Universitario Infanta Leonor, Madrid, Spain., Roa J; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Estebas C; Neurology Department, Hospital Universitario La Paz, Madrid, Spain., Díaz-de-Terán J; Neurology Department, Hospital Universitario La Paz, Madrid, Spain.; La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.
Jazyk: angličtina
Zdroj: Cephalalgia : an international journal of headache [Cephalalgia] 2024 May; Vol. 44 (5), pp. 3331024241254078.
DOI: 10.1177/03331024241254078
Abstrakt: Background: Occipital nerve stimulation (ONS) is a treatment with evidence in refractory chronic cluster headache (CCH). However, the variable response rate and cost make it necessary to investigate predictors of response.
Methods: This is a cross-sectional study conducted through the review of medical records of CCH patients from six hospitals in Madrid. Epidemiological and clinical variables were compared between patients with ONS failure and the rest. ONS failure was defined as the need for device withdrawal or switch off because of lack of response or adverse events.
Results: From a series of 88 CCH, 26 (29.6%) underwent ONS surgery, of whom 13/26 (50.0%) failed because lack of response. ONS failure group had an earlier headache onset (mean ± SD) of 27.7 ± 6.9 vs. 36.7 ± 11.8 years, p  = 0.026) and a higher smoking rate (100% vs. 42.9%, p  = 0.006). Stational fluctuations (58.3% vs. 7.7%, p  = 0.007) and nocturnal exacerbations (91.7% vs. 53.9%, p  = 0.035) were more frequent in the ONS failure group as well. There was no difference between groups in diagnostic delay, years of evolution prior to surgery, mental illness, comorbidity with other headache disorders or chronic pain conditions or prior response to occipital nerves anesthetic blocks.
Conclusions: Some clinical features such as an early debut, smoking and seasonal or circadian fluctuations could be related to failure of ONS in refractory CCH.
Competing Interests: Declaration of conflicting interestsJAM has received honoraria as a speaker from TEVA and Novartis and for advisory boards from Pfizer. AGM has received speaker honoraria from TEVA. ABGV has received honoraria for advisory boards and/or speaker panels from Novartis, Lilly, TEVA, Abbvie-Allergan, Lundbeck and Pfizer. JDT has received honoraria for advisory boards from speaker panels from Novartis, Lilly, TEVA, Abbvie-Allergan, Lundbeck Pfizer and Boston Scientific.
Databáze: MEDLINE
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