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Kollenburg L, Arnts H, Heitkamp M, Geerts S, Robinson C, Dominguez M, Mulleners W, Kurt E. Occipital nerve stimulation for cluster headache: lessons to learn from the 'voltage tuners'. J Headache Pain 2024; 25:139. [PMID: 39180011 PMCID: PMC11344319 DOI: 10.1186/s10194-024-01839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Cluster headache (CH) is a significant health concern due to its major socioeconomic consequences and most patients being refractory to conventional strategies. For treatment resistant CH, occipital nerve stimulation (ONS) is considered an effective treatment option. Whereas most patients do not adjust the amplitude of the ONS system, a subset changes the amplitude on a regular basis using their remote control, and are therefore referred to as 'voltage tuners'. Anxiety and self-control are thought to be central themes to this behavior. Research on this voltage tuning behavior could provide new insights in the use of ONS as acute attack treatment. To date, voltage tuning has not been assessed for CH. Hence this is a unique study aiming to investigate the occurrence and efficacy of voltage tuning in patients with CH and ONS. METHODS For this analysis, patients with CH who received ONS from 2020-2024, at our university medical center, were included. All patients underwent bilateral ONS implantation. Data on attack frequency, intensity and duration were collected retrospectively. Outcomes on the response, frequency, moment during the day, duration, rationale, sensation, average increase in amplitude, and efficacy of voltage tuning were collected with prospective interviews. RESULTS Thirty-three patients (M = 20) (42 ± 12.7 years) were included in the current analysis. At 1y follow-up, an overall response rate of 70% (23/33) was found for ONS. In total, 48% (18/33) of patients were defined as voltage tuners. Voltage tuning was performed with an average increase in amplitude of 92 (20-360)%, a frequency of 1-20 times/month and duration of 20 minutes-48 hours. Sensations of voltage tuning were described as "tingling" and/or "pinching". The rationale for voltage tuning in patients varied from prevention and ceasing to lowering the intensity and enhance control of CH attack. CONCLUSIONS Outcomes show that voltage tuning may cease and/or terminate CH attacks and therefore raise interests in the use of ONS as acute attack treatment for patients with resistant CH treated with ONS. Future research on the occurrence and potential of voltage tuning will provide valuable insights for achieving optimal efficacy of ONS and quality of life in patients with CH.
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Affiliation(s)
- Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands.
| | - H Arnts
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands
| | - M Heitkamp
- Department of Neurology, Canisius Wilhelmina Hospital (CWZ), Nijmegen, Netherlands
| | - S Geerts
- Department of Neurology, Canisius Wilhelmina Hospital (CWZ), Nijmegen, Netherlands
| | - C Robinson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - M Dominguez
- Department of Neurology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - W Mulleners
- Department of Neurology, Canisius Wilhelmina Hospital (CWZ), Nijmegen, Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Kurt
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands
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Xu XH, Li YM, Ren LN, Xu XF, Dai YL, Jin CQ, Yang RR. Cluster headache: understandings of current knowledge and directions for whole process management. Front Neurol 2024; 15:1456517. [PMID: 39233684 PMCID: PMC11371566 DOI: 10.3389/fneur.2024.1456517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 09/06/2024] Open
Abstract
Cluster headache (CH) is a common primary headache that severely impacts patients' quality of life, characterized by recurrent, severe, unilateral headaches often centered around the eyes, temples, or forehead. Distinguishing CH from other headache disorders is challenging, and its pathogenesis remains unclear. Notably, patients with CH often experience high levels of depression and suicidal tendencies, necessitating increased clinical attention. This comprehensive assessment combines various reports and the latest scientific literature to evaluate the current state of CH research. It covers epidemiology, population characteristics, predisposing factors, and treatment strategies. Additionally, we provide strategic insights into the holistic management of CH, which involves continuous, individualized care throughout the prevention, treatment, and rehabilitation stages. Recent advances in the field have revealed new insights into the pathophysiology of CH. While these findings are still evolving, they offer a more detailed understanding of the neurobiological mechanisms underlying this disorder. This growing body of knowledge, alongside ongoing research efforts, promises to lead to the development of more targeted and effective treatments in the future.
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Affiliation(s)
- Xiao-Hu Xu
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong, China
- Medical Laboratory, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yi-Ming Li
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong, China
- Medical Laboratory, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Li-Na Ren
- Medical Laboratory, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Xiao-Fan Xu
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong, China
- Medical Laboratory, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yi-Long Dai
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong, China
- Medical Laboratory, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Cheng-Qiang Jin
- Medical Laboratory, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Rui-Rui Yang
- Neurology Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Kuruvilla DE, Natbony L, Chandwani B, Jann A, Bradley BA, Zhang N. Complementary and Integrative Medicine for the Treatment of Trigeminal Neuralgia and Trigeminal Autonomic Cephalalgia. Curr Pain Headache Rep 2024; 28:195-203. [PMID: 38285128 DOI: 10.1007/s11916-024-01212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE OF REVIEW Trigeminal neuralgia (TN) and trigeminal autonomic cephalalgias (TACs) are both painful diseases which directly impact the branches of the trigeminal nerve, which supply the face. Patients who have experienced adverse effects, have not responded to mainstream treatments, or have a personal preference for nonmedication options, often turn to complementary and integrative medicine (CIM). The aim of this review is to discuss the efficacy and safety of CIM therapies available for the treatment of TN and TACs. RECENT FINDINGS Not only are there limited therapeutic options for TN and TAC patients, but also is there a proportion of patients who are intolerant to standard medical treatments. Recent findings have illustrated that 86% of patients with headache disorders utilize CIM modalities in combination with mainstream medical therapy. CIM modalities can be helpful for these diseases and have primarily been studied in combination with standard medical therapy. There is limited evidence for CIM and behavioral therapies in managing these conditions, and more research is needed to confirm which therapies are safe and effective.
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Affiliation(s)
- Deena E Kuruvilla
- Westport Headache Institute, 1 Turkey Hill Road South, Suite 201, Westport, CT, USA, 06880.
| | - Lauren Natbony
- Integrative Headache Medicine of New York, New York, NY, 10016, USA
| | | | | | | | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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Ganti L, Veluri SC, Stead TS, Rieck R. Ominous Causes of Headache. Curr Pain Headache Rep 2024; 28:73-81. [PMID: 38091239 DOI: 10.1007/s11916-023-01202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE OF REVIEW While primary headaches like migraines or cluster headaches are prevalent and often debilitating, it's the secondary headaches-those resulting from underlying pathologies-that can be particularly ominous. This article delves into the sinister causes of headaches, underscoring the importance of a meticulous clinical approach, especially when presented with red flags. RECENT FINDINGS Headaches, one of the most common complaints in clinical practice, span a spectrum from benign tension-type episodes to harbingers of life-threatening conditions. For the seasoned physician, differentiating between these extremes is paramount. Headache etiologies covered in this article will include subarachnoid hemorrhage (SAH), cervical artery dissection, cerebral venous thrombosis, meningitis, obstructive hydrocephalus, and brain tumor.
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Affiliation(s)
- Latha Ganti
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
- University of Central Florida College of Medicine, Orlando, FL, USA.
- Envision Healthcare, Nashville, TN, USA.
| | | | - Thor S Stead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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