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Cluster headache successfully treated by newly designed nerve pacemaker

Cluster headache successfully treated by newly designed nerve pacemaker



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Nerve pacemaker provides successful relief from cluster headaches
Cluster headaches are among the worst headaches and are often hard to bear for those affected. So far, however, the treatment options have been very limited. At the 88th annual meeting of the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO KHC) in Erfurt, the use of a nerve pacemaker in cluster headache patients is now presented as a very promising treatment alternative, reports the working group of scientists Medical societies.

Cluster headaches can be successfully relieved by using a nerve pacemaker, says Professor Dr. med. Dr. H. c. Thomas Klenzner, deputy director of the ENT clinic at the University Hospital Düsseldorf, in a press release on the 88th annual meeting of the German Society for Ear, Nose and Throat, Head and Neck Surgery. At the meeting, the expert will present the results of the clinical use of this relatively new method. According to Prof. Klenzner, a decrease or at least a reduced duration of the cluster headache can be achieved in two thirds of those affected.

Severe headache attacks without a recognizable trigger
According to the expert, cluster headaches are one of the most severe and difficult to treat headache forms. Around one in 500 people are affected, men three times more often than women. The pain often occurs suddenly and without recognizable triggers and is characterized by a daily rhythm, reports Prof. Klenzner. The attacks would often start during sleep and last between 15 and 180 minutes.

Unilateral headache in episodic cluster
In cluster headaches, "the main pain usually occurs one-sided around or behind the eye and practically never changes sides," explains the deputy director of the ENT clinic at the University Clinic in Düsseldorf. The pain was described by those affected as "unbearably violent, tearing, boring, sometimes even burning." There was a change between periods with a high accumulation (English cluster) of headache attacks and differently long, symptom-free intervals.

Limited treatment options for cluster headache
The cluster headaches are usually treated with migraine drugs in the form of so-called triptans. To achieve a quick effect, they are injected under the skin or used as a nasal spray. Furthermore, the inhalation of 100 percent oxygen via a face mask is also said to have a pain-relieving effect. But both therapies are cumbersome to use and do not achieve the hoped-for effect in all patients, reports Professor Klenzner.

Nerve pacemakers are a relatively new alternative
As an alternative to drug treatment, a pacemaker has recently been implanted. This treatment is based on the knowledge that the trigeminal nerve is significantly involved in the development of pain. The facial nerve has a switching station, a nerve node called the sphenopalatine ganglion (SPG), explains the expert. "It has long been known that anesthetic of the ganglion can relieve cluster headache," Professor Klenzner continued. The SPG is located under the skull base behind the maxillary bone in a bone pit and there have previously been treatments in which this was anesthetized by injections of cocaine or alcohol. However, this was difficult and risky and was rarely carried out.

Stimulator controllable by the patient
A similar anesthetic effect of the SPG is to be achieved with the nerve pacemaker, whereby the patients can control it independently, explains Prof. For this purpose, a nerve stimulator the size of a fingernail is implanted through a wall of the oral cavity near the SPG. The pulse generator is provided with an electrode wire that electrically stimulates the SPG via several contacts. After the operation, patients can activate the SPG stimulator with a remote control on the cheek and thus alleviate the cluster headache, the expert continues. In the “Pathway CH-1” study, this method eliminated the pain in two thirds of the patients or shortened the attacks and also reduced the number of pain attacks.

So far around 400 nerve pacemakers have been implanted
According to Professor Klenzner, around 400 patients worldwide have been treated with a nerve pacemaker, including ten patients in Düsseldorf. The operational and technical procedure is relatively demanding and requires extensive preparation and thorough training. Using a virtual 3D model of the skull, the right model is selected for each patient and a trial stimulation takes place during the operation. According to Prof. Klenzner, all of the patients in Düsseldorf essentially tolerated the implantation well and four weeks after the operation there was a decrease in the frequency of seizures and pain intensity. "SPG stimulation will find its place in clinical care", Prof. (fp) is convinced

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Video: Differentiating Cluster Headaches from other Trigeminal Autonomic Cephalalgia (August 2022).