Occipital nerve stimulation for chronic cluster headache

The greater occipital nerve has been implicated in the pain associated with cluster headache. Prophylactic medication is ineffective for a significant number of patients with chronic cluster headache and previous treatment options have consisted of ablative procedures carrying the potential for significant neurological morbidity. Greater occipital nerve stimulation may represent a safe and effective treatment option for chronic medically refractory cluster headache and warrants further study. Cluster headache often manifests with severe pain, but most patients can be effectively treated with currently available medications. However, between 15% and 20% of these patients develop chronic cluster headache that is refractory to medical management. Treatment options in severe chronic cluster headache cases have included neurolytic or ablative surgery involving the trigeminal or autonomic pathways using radiofrequency, glycerol rhizotomy, and even trigeminal nerve section at the brain stem level. Although sometimes effective, these procedures are invasive, are associated with a significant recurrence rate, and carry the potential for significant neurological morbidity.