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Percutaneous occipital nerve stimulation (ONS) is a useful approach in the treatment of refractory chronic cluster headache (rCCH).
Percutaneous occipital nerve
stimulation (ONS) is a useful approach in the treatment of refractory chronic
cluster headache (rCCH). Responders to ONS vary from non-responders by higher
glucose metabolism in subgenual anterior cingulate cortex (sgACC). The study
demonstrated that direct current stimulation (tDCS) might be capable of
stimulating this area and consequently can improve rCCH patients state. The
purpose of the analysis was to examine the therapeutic potential of tDCS and
associated potential influences on frontal executive functions, mood, and pain
perception in rCCH patients.
A total of 31 patients were
invited to implement daily 20-min sittings of 2 mA tDCS for 4 or 8 weeks
following a 1-month baseline. Paper diaries were used to observe CH attacks.
There was a change observed in primary outcome measures in weekly attacks
between baseline and the last week of tDCS. For a modified ITT and protocol
analysis, a total of 23 and 21 patients were involved, respectively. The
treatment-related changes in frontal lobe function, mood and thermal pain
thresholds and nociceptive blink reflexes (nBR) scales were also examined.
A mean 35% decline in attack
incidence with 41% of patients with a ≥ 50% reduction was noticed in the
per-protocol analysis. The attack severity and duration were also decreased
considerably. The 50% responder rate
noticed to be 45% after 8 weeks. However, the mean attack incidence had
reversed to baseline levels at the follow-up 2 weeks after tDCS. The patients
with high baseline thermal pain thresholds in the forehead showed a significant
treatment effect. An increase was seen in the Frontal Assessment Battery score.
Whereas, depression scores or nBR showed no variations.
tDCS with an Fz-C7 montage
presents as a preventive approach in rCCH patients, particularly those with low
pain responsiveness, proposing that a sham-controlled examination in a cluster
headache is essential. Further analysis is still needed to determine whether
the therapeutic impact is due to sgACC activation or of other prefrontal
cortical.
J Headache Pain
Anodal frontal tDCS for chronic cluster headache treatment: a proof-of-concept trial targeting the anterior cingulate cortex and searching for nociceptive correlates.
Delphine Magis et al.
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