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Cluster headache successfully treated by newly designed nerve pacemaker
Cluster headaches are among the worst headaches and are often hard to bear for those affected. So far, however, the treatment options have remained very limited. At the 88th annual meeting of the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO KHC) in Erfurt, the application of a nerve pacemaker in cluster headache patients is now presented as a promising alternative treatment, reports the Association of Scientific Medical societies.
By using a nerve pacemaker, cluster headaches can be successfully alleviated. med. Dr. H. c. Thomas Klenzner, Deputy Director of the Otolaryngology Department at the University Hospital Düsseldorf, in a press release for the 88th Annual Meeting of the German Society of Otolaryngology, Head and Neck Surgery. At the meeting, the expert will present the results of the clinical use of this relatively new method. In two-thirds of those affected, a subsidence or at least a shortened duration of the cluster headache was achievable, according to Prof. Klenzner in advance.
Cluster headache is often felt to be unbearable in its intensity. The implantation of a nerve pacemaker can help them openly. (Picture: Picture-Factory / fotolia.com) Heaviest headache attacks without recognizable trigger
Cluster headache, according to the expert, is one of the heaviest and most difficult to treat types of headaches. About one in 500 people is affected, men three times more often than women. The pain often occurs abruptly and without recognizable triggers and is characterized by a daily rhythm, reports Prof. Klenzner. Often the attacks would take place during sleep, lasting between 15 and 180 minutes.
Unilateral headache in episodic accumulation
In cluster headaches "the main pain usually occurs unilaterally around the eye or behind the eye (on) and almost never changes the side," explains the Deputy Director of the ENT Department at the University Hospital Dusseldorf. The pain is described by those affected as "unbearably violent, tearing, boring, sometimes burning as synonymous." There is a change between periods with a strong accumulation (cluster) of headache attacks and different length, symptom-free intervals noted.
Limited treatment options for cluster headache
The cluster headache is usually treated with migraine remedies in the form of so-called triptans. To achieve a rapid effect, they are injected under the skin or used as a nasal spray. Furthermore, the inhalation of 100 percent oxygen through a face mask is also believed to relieve pain. But both therapies are cumbersome in the application and they do not achieve the desired effect in all patients, reports Professor Klenzner.
Nerve pacemaker a relatively new alternative
As an alternative to the drug treatment, the implantation of a nerve pacemaker has recently been carried out. This treatment is based on the knowledge that the trigeminal nerve is involved in the development of pain. The facial nerve has a switching station, a nerve cell called the sphenopalatine ganglion (SPG), explains the expert ... "It has long been known that anesthetization of the ganglion can alleviate cluster headache," continues Professor Klenzner. The SPG is located under the skull base behind the maxillary bone in a bone pit and there have been previous treatments that have been anesthetized by injections of cocaine or alcohol. However, that was difficult and risky and rarely done.
Stimulator controllable by the patient
With the nerve pacemaker a similar numbing effect of the SPG is to be achieved, whereby the patients can control these independently, explains Prof. Klenzner. 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 electric wire that electrically stimulates the SPG via several contacts. Patients can activate the SPG stimulator after surgery with a remote control on the cheek, thus weakening the cluster headache, the expert continued. In the study "Pathway CH-1", this procedure eliminated the pain in two-thirds of the patients or shortened the attacks and also reduced the number of pain attacks.
So far, about 400 nerve pacemaker implanted
So far, according to Professor Klenzner, around 400 patients have been treated with a nerve pacemaker, including ten patients in Düsseldorf. The operative and technical procedure is relatively demanding and requires extensive preparation and thorough training. Based on a virtual 3D model of the skull, the right model will be selected for each patient, and a trial will be carried out during the operation. According to Prof. Klenzner, all of the patients in Dusseldorf have tolerated the implantation substantially well, and four weeks after the operation a decrease in seizure frequency and pain intensity has been noted. "The SPG stimulation will find its place in the clinical care", so the conviction of Prof. Klenzner. (Fp)