How effective is non-invasive vagus nerve stimulation for cluster headache?

Initial use of a novel noninvasive vagus nerve stimulator for cluster headache treatment

Nesbitt AD, Marin JC, Tompkins E, Ruttledge MH, Goadsby PJ.

Neurology 2015; 84:1249-1253.

Abstract

OBJECTIVE:

To report our initial experience with a novel device, designed to provide portable, noninvasive, transcutaneous stimulation of the vagus nerve, both acutely and preventively, as a treatment for cluster headache.

METHODS:

Patients with cluster headache (11 chronic, 8 episodic), from 2 centers, including 7 who were refractory to drug treatment, had sufficient data available for analysis in this open-label observational cohort study. The device, known as the gammaCore, was used acutely to treat individual attacks as well as to provide prevention. Patient-estimated efficacy data were collected by systematic inquiry during follow-up appointments up to a period of 52 weeks of continuous use.

RESULTS:

Fifteen patients reported an overall improvement in their condition, with 4 reporting no change, providing a mean overall estimated improvement of 48%. Of all attacks treated, 47% were aborted within an average of 11 ± 1 minutes of commencing stimulation. Ten patients reduced their acute use of high-flow oxygen by 55% with 9 reducing triptan use by 48%. Prophylactic use of the device resulted in a substantial reduction in estimated mean attack frequency from 4.5/24 hours to 2.6/24 hours (p < 0.0005) posttreatment.

CONCLUSION:

These data suggest that noninvasive vagus nerve stimulation may be practical and effective as an acute and preventive treatment in chronic cluster headache. Further evaluation of this treatment using randomized sham-controlled trials is thus warranted.

CLASSIFICATION OF EVIDENCE:

This study provides Class IV evidence that for patients with cluster headache, transcutaneous stimulation of the vagus nerve aborts acute attacks and reduces the frequency of attacks.

You may also check:

Noninvasive vagus nerve stimulation in the management of cluster headache: clinical evidence and practical experience.

Holle-Lee D, Gaul C.

Ther Adv Neurol Disord 2016; 9:230-234.

These references are both included in the neurochecklist:

Cluster headache (CH): prophylactic treatment

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Abstract link

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 793, Public Domain, Link
By Henry Vandyke CarterHenry Gray (1918) Anatomy of the Human Body (See “Book” section below)Bartleby.com: Gray’s Anatomy, Plate 793, Public Domain, Link

 

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