Long-term effectiveness of combined unilateral sphenopalatine and occipital nerve stimulation in patients with refractory chronic cluster headache

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Introduction Cluster headache is an extremely debilitating and often difficult-to-treat headache disorder characterized by recurrent attacks of excruciating pain associated with cranial autonomic symptoms. Several invasive neuromodulation procedures have been evaluated in the past, but the combination of these procedures to maximize response has not been studied in groups of patients. Materials and methods In this single-center, retrospective, observational study, we present the long-term clinical evolution of seven patients suffering from refractory chronic cluster headache (CCH), treated with combined sphenopalatine ganglion (SPG) and greater occipital nerve (GON) invasive stimulation, ipsilateral to the side of the pain, between February 2010 and March 2021. The Visual Analogue Scale (VAS) and Headache Impact Test (HIT-6) were used to monitor the response. Results The mean follow-up time was 5.8 years ± 3.4 years (maximum 10.4 years). Six out of the seven patients experienced good-to-excellent initial pain relief and achieved almost complete remission of symptoms afterwards. Mean VAS and HIT-6 score values decreased significantly and steadily during most of the observation period. Electrode migration requiring reintervention occurred in two patients. Conclusion Synergistic invasive SPG-GON stimulation is a relatively safe and promising alternative for effective and long-lasting control of CCH. Further studies involving larger samples are warranted.