A good preoperative response to transcutaneous electrical nerve stimulation predicts a better therapeutic effect of implanted occipital nerve stimulation in pharmacologically intractable headaches

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• 作者：Jean-Paul Nguyen^a ; ^b ; ^d ; Julien Nizard^a ; ^{julien.nizard@univ-nantes.fr" class="auth_mail" title="E-mail the corresponding author} ; Emmanuelle Kuhn^a ; Florence Carduner^a ; Fré ; dé ; rique Penverne^a ; Marie-Christine Verleysen-Robin^d ; Luc Terreaux^b ; Solè ; ne de Gaalon^a ; Sylvie Raoul^b ; Jean-Pascal Lefaucheur^c
• 关键词：Cervicogenic headache ; Chronic headache ; Chronic migraine ; Cluster headache ; Occipital nerve stimulation ; Occipital neuralgia ; Transcutaneous electrical nerve stimulation
• 刊名：Neurophysiologie Clinique / Clinical Neurophysiology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：46
• 期：1
• 页码：69-75
• 全文大小：731 K

文摘

Occipital nerve stimulation (ONS) is a surgical approach to treat patients with medically intractable chronic headache disorders. However, no preoperative test has been yet validated to allow candidates to be selected for implantation. In this study, the analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) was tested for 1 to 3 months in 41 patients with pharmacologically intractable headache disorders of various origins, using a new technique of electrode placement over the occipital nerve. ONS electrodes were subsequently implanted in 33 patients (occipital neuralgia [n = 15], cervicogenic headache [n = 7], cluster headache [n = 6], chronic migraine [n = 5]) who had responded at least moderately to TENS. Assessment was performed up to five years after implantation (three years on average), based on the mean and maximum daily pain intensity scored on a 0-10 visual analogue scale and the number of headache days per month. Both TENS and chronic ONS therapy were found to be efficacious (57–76% improvement compared to baseline on the various clinical variables). The efficacy of ONS was better in cases of good or very good preoperative response to TENS than in cases of moderate response to TENS. Implanted ONS may be a valuable therapeutic option in the long term for patients with pharmacologically intractable chronic headache. Although we cannot conclude in patients with poor or no response to TENS, a good or very good response to TENS can support the indication of ONS therapy. This preoperative test could particularly be useful in patients with chronic migraine, in whom it may be difficult to indicate an invasive technique of cranial neurostimulation.