Neurological Sciences

, Volume 33, Supplement 1, pp 33–35 | Cite as

Drug-resistant chronic migraine: the Italian GON project

  • A. Proietti Cecchini
  • M. Leone
  • G. C. Manzoni
  • P. Torelli
  • G. Bussone


Chronic daily headache is a major problem due to severe disability and high socio-economic costs. In the last years, some trials have shown potential benefit from new therapeutic approach by occipital neurostimulation techniques, already applied with some success for the treatment of chronic cluster headache. Due to the extremely heterogeneous population suffering from refractory chronic daily headaches, we propose a national multicenter experimental study involving Italian ANIRCEF Headache Centres with the aim to evaluate the efficacy of occipital neurostimulation in a selected group representative for the drug-resistant chronic migraine. Patients with chronic migraine according to Manzoni’s modified IHS criteria-2011, with or without medication overuse headache, will be selected. Duration of illness should be at least 2 years and pharmacological refractoriness defined strictly for experimental-surgical purposes as those patients who have properly tried without success almost all available classes of prophylactic medications. Those presenting with medication overuse should have tried at least two previous detoxification treatments. A full psychopathological assessment will be performed by a psychiatrist, to exclude mainly psychotic disorder, ongoing severe status of an affective disorder, severe post traumatic stress disorder. Headache characteristics and abortive treatments used will be reported daily on a predisposed diary during 3-month baseline and continuously through the post implant follow up, while disability and QoL scale (MIDAS, SF-12) will be completed baseline, 6 and 12 months after implant.


Neuromodulation Occipital nerve stimulation Chronic daily headache Chronic migraine Drug-resistant headache 


  1. 1.
    Leone M, Franzini A, Cecchini AP, Mea E, Broggi G, Bussone G (2010) Deep brain stimulation in trigeminal autonomic cephalalgias. Neurotherapeutics 7(2):220–228PubMedCrossRefGoogle Scholar
  2. 2.
    Magis D, Gerardy PY, Remacle JM, Schoenen J (2011) Sustained effectiveness of occipital nerve stimulation in drug-resistant chronic cluster headache. Headache 51(8):1191–1201PubMedCrossRefGoogle Scholar
  3. 3.
    Lambru G, Matharu MS (2012) Occipital nerve stimulation in primary headache syndromes. Ther Adv Neurol Disord 5(1):57–67PubMedCrossRefGoogle Scholar
  4. 4.
    Weiner RL, Reed KL (1999) Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation 2(3):217–221PubMedCrossRefGoogle Scholar
  5. 5.
    Oh MY, Ortega J, Bellotte JB, Whiting DM, Aló K (2004) Peripheral nerve stimulation for the treatment of occipital neuralgia and transformed migraine using a c1-2-3 subcutaneous paddle style electrode: a technical report. Neuromodulation 7(2):103–112PubMedCrossRefGoogle Scholar
  6. 6.
    Popeney CA, Aló KM (2003) Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine. Headache 43(4):369–375PubMedCrossRefGoogle Scholar
  7. 7.
    Saper JR, Dodick DW, Silberstein SD, McCarville S, Sun M, Goadsby PJ, ONSTIM Investigators (2011) Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalalgia 31(3):271–285PubMedCrossRefGoogle Scholar
  8. 8.
    Lipton RB, Goadsby PJ, Cady RK, Aurora SK, Grosberg BM, Freitag FG, Silberstein SD, Whiten DM, Jaax KN (2010) PRISM study: occipital nerve stimulation for treatment refractory migraine. Headache 50:515Google Scholar
  9. 9.
    Silberstein S, Dodick D, Saper J, Huh B, Reed K, Narouze S, Bacon D, Mogilner A, Banks J, Cady R, Black S, Slavin K, Goldstein J, Markley H, Deer T, Levy R, Mekhail N (2011) The safety and efficacy of occipital nerve stimulation for the management of chronic migraine. Cephalalgia 31:117Google Scholar
  10. 10.
    Synofzik M, Schlaepfer TE (2011) Electrodes in the brain–ethical criteria for research and treatment with deep brain stimulation for neuropsychiatric disorders. Brain Stimul 4(1):7–16PubMedCrossRefGoogle Scholar
  11. 11.
    Manzoni GC, Bonavita V, Bussone G, Cortelli P, Narbone MC, Cevoli S, D’Amico D, De Simone R, Torelli P, ANIRCEF (Associazione Neurologica Italiana per la Ricerca sulle Cefalee) (2011) Chronic migraine classification: current knowledge and future perspectives. J Headache Pain 12(6):585–592PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • A. Proietti Cecchini
    • 1
  • M. Leone
    • 1
  • G. C. Manzoni
    • 2
  • P. Torelli
    • 2
  • G. Bussone
    • 1
  1. 1.Headache Centre, Neuromodulation Unit and Neurological DepartmentFondazione IRCCS, Istituto Neurologico Carlo BestaMilanItaly
  2. 2.Headache CentreUniversity of ParmaParmaItaly

Personalised recommendations