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  • Long Term Follow-up in Functional Outcomes of Combined Supraorbital Nerve Stimulation and Occipital Nerve Stimulation for Chronic Headache Patients

    Final Number:

    Shannon Wang Clark MD; Chengyuan Wu MD, MSBmE; David Boorman; Nohra Chalouhi MD; Mario Zanaty MD; Ashwini Dayal Sharan MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Dual supraorbital and occipital nerve stimulation (SONS and ONS) have shown promising efficacy in treating primary headaches. However, its functional outcome is not well studied. We report functional outcome of combined SONS and ONS for migraine using verified metrics.

    Methods: Consecutive patients who have both supraorbital and occipital nerve stimulators and also underwent Migraine Disability Assessment (MIDAS) and Beck Depression Index (BDI) both pre- and post-operatively were studied. Outcome variables included net improvement of ranked MIDAS and BDI scores. Predictor variables included patients with =50% improvement of pain, disability status, number of years from diagnosis to implantation, and narcotic use. Multivariate analysis of variance (MANOVA) was performed to assess the correlation between the outcome and predictor variables.

    Results: Sixteen patients (12 female; age avg. 51.8 y.o.) were studied. Follow-up ranged from 5-80months (avg.44.5±21.4 months). Eight had a positive response (=50% improvement in headache) at most recent follow-up. =50 % improvement in headache was the only predictor of outcome variables combined (total MIDAS, MIDAS-B and BDI)(p=0.021). Of note, this improvement in functional outcome was only significant during the perioperative period and not throughout the length of follow up. No other predictive factors were significantly correlated with the functional outcomes. Among the predictor variables, a strong correlation was found for disability status being inversely related to reporting =50% improvement in headache (r=-0.582).

    Conclusions: In patients who had positive response to SONS and ONS, functional status as reflected by MIDAS and BDI had overall improvement in perioperative period. Unfortunately, this effect waned over the long-term follow-up.

    Patient Care: Modalities of peripheral nerve stimulation such as supraorbital nerve stimulation (SONS) or occipital nerve stimulation (ONS) has been increasingly used for treatment of primary headache in the past decade. In author’s institution, combined SONS and ONS have been performed for many patients suffering from migraine and have series of patients who respond better to combined therapy than ONS alone therapy. However, functional outcome studies of these peripheral nerve stimulation for headaches are scarce and whether this therapy can improve quality of life and depression among the headache populations are largely unknown. Moreover, there has been no previous functional outcome of combined ONS and SONS stimulation published previously. Authors followed patients who are implanted with both ONS and SONS for long-term and collected their quality of life status pre and post treatment using verified metrics for migraine. This article adds new knowledge of functional outcome benefit that neuromodulation provides in chronic migraine patients.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of assessing functional outcome of peripheral nerve stimulation for headache, 2) Discuss, in small groups why dual stimulation at supraorbital and occipital nerve site could be more effective than occipital nerve stimulation alone, 3) Identify an effective metrics of assessing functional efficacy of neuromodulation therapy in migraine and how we can successfully collect these data.


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