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Subkutane periphere Stimulation des N. occipitalis major zur Behandlung chronischer Kopfschmerzsyndrome

Subcutaneous peripheral stimulation of the greater occipital nerve for the treatment of chronic headache syndromes

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Zusammenfassung

Die medikamentöse Therapie bestimmter Kopfschmerzsyndrome wie der chronischen Hemikranie (HC), chronischen Migräne (CM) oder dem chronischen Cluster-Kopfschmerz (CCH) führt in vielen Fällen nicht zu befriedigenden Ergebnissen oder ist durch intolerable Nebenwirkungen erschwert. In den letzten Jahren haben sich auch für diese Schmerzerkrankungen neuromodulative Therapien wie die subkutane Stimulation des N. occipitalis major oder die tiefe Hirnstimulation (DBS) im Hypothalamus entwickelt. Diese Arbeit soll eine Übersicht über den derzeitigen Wissensstand und die Resultate der subkutanen peripheren Nervenstimulation (SPNS) in der Literatur bei den beschriebenen Kopfschmerzformen geben und eigene Ergebnisse bei insgesamt 10 Patienten vorstellen. Hierbei wird auf technische Details bei der Implantation und mögliche Komplikationen eingegangen. Die Ergebnisse bei Cluster-Kopfschmerz werden mit denen der tiefen Hirnstimulation verglichen. Zusammenfassend lässt sich sagen, dass die SPNS beim Cluster-Kopfschmerz als weniger invasives Verfahren zwar nicht so erfolgreich ist wie die tiefe Hirnstimulation, aber dennoch die Häufigkeit und Schwere der Attacken signifikant reduzieren kann. Für andere Kopfschmerzformen bietet sie eine sinnvolle Ergänzung zur medikamentösen Therapie.

Abstract

Medical treatment for certain chronic headache syndromes such as hemicrania continua (HC), chronic migraine (CM) or chronic cluster headache (CCH) is challenging and in many cases does not lead to sufficient pain relief or is limited by severe side effects. In the last few years neuromodulatory treatments such as subcutaneous stimulation of the greater occipital nerve or deep brain stimulation (DBS) in the hypothalamus have evolved. This report focuses on current knowledge and the results of peripheral subcutaneous nerve stimulation (SPNS) in the literature of the described headache syndromes and presents our own long-term results in ten patients. Technical details of implantation and possible complications are reported. The results between the two different stimulation types are compared. In summary, peripheral nerve stimulation of the greater occipital nerve is less invasive but also less effective in comparison to hypothalamic stimulation. However, the severity and frequency of pain attacks is significantly reduced. For other intractable headache syndromes SPNS of the greater occipital nerve offers a reasonable addition to medical treatment.

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  1. Neurochirurgische Univ.-Klinik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    V. Tronnier & D. Rasche

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  2. D. Rasche
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Correspondence to V. Tronnier.

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Tronnier, V., Rasche, D. Subkutane periphere Stimulation des N. occipitalis major zur Behandlung chronischer Kopfschmerzsyndrome. Schmerz 24, 441–448 (2010). https://doi.org/10.1007/s00482-010-0970-7

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