BACKGROUND Occipital nerve stimulation (ONS) has been proposed to treat refractory chronic cluster headache (rCCH) but its efficacy has only been showed in small short-term series. OBJECTIVE To evaluate ONS long-term efficacy in rCCH. METHODS We studied 105 patients with rCCH, treated by ONS within a multicenter ONS prospective registry. Efficacy was evaluated by frequency, intensity of pain attacks, quality of life (QoL) EuroQol 5 dimensions (EQ5D), functional (Headache Impact Test-6, Migraine Disability Assessment) and emotional (Hospital Anxiety Depression Scale [HAD]) impacts, and medication consumption. RESULTS At last follow-up (mean 43.8 mo), attack frequency was reduced >50% in 69% of the patients. Mean weekly attack frequency decreased from 22.5 at baseline to 9.9 (P < .001) after ONS. Preventive and abortive medications were significantly decreased. Functional impact, anxiety, and QoL significantly improved after ONS. In excellent responders (59% of the patients), attack frequency decreased by 80% and QoL (EQ5D visual analog scale) dramatically improved from 37.8/100 to 73.2/100. When comparing baseline and 1-yr and last follow-up outcomes, efficacy was sustained over time. In multivariable analysis, low preoperative HAD-depression score was correlated to a higher risk of ONS failure. During the follow-up, 67 patients experienced at least one complication, 29 requiring an additional surgery: infection (6%), lead migration (12%) or fracture (4.5%), hardware dysfunction (8.2%), and local pain (20%). CONCLUSION Our results showed that long-term efficacy of ONS in CCH was maintained over time. In responders, ONS induced a major reduction of functional and emotional headache-related impacts and a dramatic improvement of QoL. These results obtained in real-life conditions support its use and dissemination in rCCH patients.

中文翻译：

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枕神经刺激治疗顽固性丛集性头痛的长期疗效

背景 枕神经刺激 (ONS) 已被提议用于治疗难治性慢性丛集性头痛 (rCCH)，但其疗效仅在小型短期系列中显示。目的 评估 ONS 在 rCCH 中的长期疗效。方法 我们在多中心 ONS 前瞻性注册研究中研究了 105 名接受 ONS 治疗的 rCCH 患者。通过频率、疼痛发作强度、生活质量 (QoL) EuroQol 5 维度 (EQ5D)、功能（头痛影响测试-6、偏头痛残疾评估）和情绪（医院焦虑抑郁量表 [HAD]）影响评估疗效，以及药物消耗。结果 在最后一次随访时（平均 43.8 个月），69% 的患者的发作频率降低了 >50%。ONS 后平均每周发作频率从基线时的 22.5 下降到 9.9（P < .001）。预防性和流产性药物显着减少。ONS 后功能影响、焦虑和 QoL 显着改善。在反应良好的患者（59% 的患者）中，发作频率降低了 80%，QoL（EQ5D 视觉模拟量表）从 37.8/100 显着提高到 73.2/100。当比较基线和 1 年和最后一次随访结果时，疗效会随着时间的推移而持续。在多变量分析中，较低的术前 HAD 抑郁评分与较高的 ONS 失败风险相关。在随访期间，67 名患者出现至少一种并发症，29 名需要额外手术：感染 (6%)、铅迁移 (12%) 或骨折 (4.5%)、硬件功能障碍 (8.2%) 和局部疼痛 ( 20%）。结论 我们的结果表明，随着时间的推移，ONS 在 CCH 中的长期疗效保持不变。在响应者中，ONS 显着减少了与功能性和情绪性头痛相关的影响，并显着改善了 QoL。在现实生活条件下获得的这些结果支持其在 rCCH 患者中的使用和传播。