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Occipital nerve stimulation for chronic migraine--a systematic review and meta-analysis.

Chen YF, Bramley G, Unwin G, Hanu-Cernat D, Dretzke J, Moore D, Bayliss S, Cummins C, Lilford R - PLoS ONE (2015)

Bottom Line: Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95% CI 0.91 to 4.27, I2=0%) of prolonged, moderate to severe headache per month at 3 months compared with a sham control.Further measures to reduce the risk of adverse events and revision surgery are needed. this systematic review is an update and expanded work of part of a broader review registered with PROSPERO.CRD42012002633.

View Article: PubMed Central - PubMed

Affiliation: School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom; Division of Health Sciences, University of Warwick, Coventry, United Kingdom.

ABSTRACT

Background: Chronic migraine is a debilitating headache disorder that has significant impact on quality of life. Stimulation of peripheral nerves is increasingly being used to treat chronic refractory pain including headache disorders. This systematic review examines the effectiveness and adverse effects of occipital nerve stimulation (ONS) for chronic migraine.

Methods: Databases, including the Cochrane Library, MEDLINE, EMBASE, CINAHL and clinical trial registers were searched to September 2014. Randomized controlled trials (RCTs), other controlled and uncontrolled observational studies and case series (n≥ 10) were eligible. RCTs were assessed using the Cochrane risk of bias tool. Meta-analysis was carried out using a random-effects model. Findings are presented in summary tables and forest plots.

Results: Five RCTs (total n=402) and seven case series (total n=115) met the inclusion criteria. Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95% CI 0.91 to 4.27, I2=0%) of prolonged, moderate to severe headache per month at 3 months compared with a sham control. Results for other outcomes generally favour ONS over sham controls but quantitative analysis was hampered by incomplete publication and reporting of trial data. Lead migration and infections are common and often require revision surgery. Open-label follow-up of RCTs and case series suggest long-term effectiveness can be maintained in some patients but evidence is limited.

Conclusions: While the effectiveness of ONS compared to sham control has been shown in multiple RCTs, the average effect size is modest and may be exaggerated by bias as achieving effective blinding remains a methodological challenge. Further measures to reduce the risk of adverse events and revision surgery are needed.

Systematic review registration: this systematic review is an update and expanded work of part of a broader review registered with PROSPERO. Registration No. CRD42012002633.

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Related in: MedlinePlus

Adverse effects associated with implantation and/or use of occipital nerve stimulation: lead migrations.
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pone.0116786.g004: Adverse effects associated with implantation and/or use of occipital nerve stimulation: lead migrations.

Mentions: Lead migration/dislodgement was common (Fig. 4). As expected higher rates were seen in case series with longer follow-up. One case series [35] suggests that using paddle-type leads rather than cylindrical leads can reduce the occurrence of lead migration. Measures were instigated during the ONSTIM trial to reduce lead migration [17], including the use of circular coils when placing the lead extension to create strain-relief loops, and choosing the abdomen in preference of the buttock as the implant location for the pulse generator. However, the impact of these measures was not formally assessed.


Occipital nerve stimulation for chronic migraine--a systematic review and meta-analysis.

Chen YF, Bramley G, Unwin G, Hanu-Cernat D, Dretzke J, Moore D, Bayliss S, Cummins C, Lilford R - PLoS ONE (2015)

Adverse effects associated with implantation and/or use of occipital nerve stimulation: lead migrations.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4368787&req=5

pone.0116786.g004: Adverse effects associated with implantation and/or use of occipital nerve stimulation: lead migrations.
Mentions: Lead migration/dislodgement was common (Fig. 4). As expected higher rates were seen in case series with longer follow-up. One case series [35] suggests that using paddle-type leads rather than cylindrical leads can reduce the occurrence of lead migration. Measures were instigated during the ONSTIM trial to reduce lead migration [17], including the use of circular coils when placing the lead extension to create strain-relief loops, and choosing the abdomen in preference of the buttock as the implant location for the pulse generator. However, the impact of these measures was not formally assessed.

Bottom Line: Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95% CI 0.91 to 4.27, I2=0%) of prolonged, moderate to severe headache per month at 3 months compared with a sham control.Further measures to reduce the risk of adverse events and revision surgery are needed. this systematic review is an update and expanded work of part of a broader review registered with PROSPERO.CRD42012002633.

View Article: PubMed Central - PubMed

Affiliation: School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom; Division of Health Sciences, University of Warwick, Coventry, United Kingdom.

ABSTRACT

Background: Chronic migraine is a debilitating headache disorder that has significant impact on quality of life. Stimulation of peripheral nerves is increasingly being used to treat chronic refractory pain including headache disorders. This systematic review examines the effectiveness and adverse effects of occipital nerve stimulation (ONS) for chronic migraine.

Methods: Databases, including the Cochrane Library, MEDLINE, EMBASE, CINAHL and clinical trial registers were searched to September 2014. Randomized controlled trials (RCTs), other controlled and uncontrolled observational studies and case series (n≥ 10) were eligible. RCTs were assessed using the Cochrane risk of bias tool. Meta-analysis was carried out using a random-effects model. Findings are presented in summary tables and forest plots.

Results: Five RCTs (total n=402) and seven case series (total n=115) met the inclusion criteria. Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95% CI 0.91 to 4.27, I2=0%) of prolonged, moderate to severe headache per month at 3 months compared with a sham control. Results for other outcomes generally favour ONS over sham controls but quantitative analysis was hampered by incomplete publication and reporting of trial data. Lead migration and infections are common and often require revision surgery. Open-label follow-up of RCTs and case series suggest long-term effectiveness can be maintained in some patients but evidence is limited.

Conclusions: While the effectiveness of ONS compared to sham control has been shown in multiple RCTs, the average effect size is modest and may be exaggerated by bias as achieving effective blinding remains a methodological challenge. Further measures to reduce the risk of adverse events and revision surgery are needed.

Systematic review registration: this systematic review is an update and expanded work of part of a broader review registered with PROSPERO. Registration No. CRD42012002633.

Show MeSH
Related in: MedlinePlus