背景:丛集性头痛(CH)是一个重要的健康问题,由于其主要的社会经济后果,并且大多数患者对常规策略难以治疗。对于治疗抗性CH,枕神经刺激(ONS)被认为是一种有效的治疗选择。虽然大多数患者不调整ONS系统的幅度,一个子集使用他们的遥控器定期改变振幅,因此称为“电压调谐器”。焦虑和自我控制被认为是这种行为的中心主题。对这种电压调谐行为的研究可以为使用ONS作为急性发作治疗提供新的见解。迄今为止,电压调谐尚未评估CH。因此,这是一项独特的研究,旨在研究CH和ONS患者电压调节的发生和功效。
方法:对于此分析,从2020-2024年在我们的大学医学中心接受ONS的CH患者,包括在内。所有患者均行双侧ONS植入术。攻击频率数据,对强度和持续时间进行回顾性收集.回应的结果,频率,白天的时刻,持续时间,理由,感觉,振幅平均增加,并通过前瞻性访谈收集了电压调谐的功效。
结果:本分析包括33例患者(M=20)(42±12.7年)。在1y随访时,ONS的总应答率为70%(23/33).总的来说,48%(18/33)的患者被定义为电压调谐器。进行电压调谐,振幅平均增加92(20-360)%,频率为1-20次/月,持续时间为20分钟-48小时。电压调谐的感觉被描述为“刺痛”和/或“捏”。患者电压调节的基本原理从预防和停止到降低强度并增强对CH发作的控制各不相同。
结论:结果显示,电压调节可以停止和/或终止CH发作,因此提高了对ONS治疗耐药CH患者使用ONS作为急性发作治疗的兴趣。关于电压调谐的发生和潜力的未来研究将为实现ONS的最佳疗效和CH患者的生活质量提供有价值的见解。
BACKGROUND: Cluster headache (CH) is a significant health concern due to its major socioeconomic consequences and most patients being refractory to conventional strategies. For treatment resistant CH, occipital nerve stimulation (ONS) is considered an effective treatment option. Whereas most patients do not adjust the amplitude of the ONS system, a subset changes the amplitude on a regular basis using their remote control, and are therefore referred to as \'voltage tuners\'. Anxiety and self-control are thought to be central themes to this behavior. Research on this
voltage tuning behavior could provide new insights in the use of ONS as acute attack treatment. To date,
voltage tuning has not been assessed for CH. Hence this is a unique study aiming to investigate the occurrence and efficacy of voltage tuning in patients with CH and ONS.
METHODS: For this analysis, patients with CH who received ONS from 2020-2024, at our university medical center, were included. All patients underwent bilateral ONS implantation. Data on attack frequency, intensity and duration were collected retrospectively. Outcomes on the response, frequency, moment during the day, duration, rationale, sensation, average increase in amplitude, and efficacy of voltage tuning were collected with prospective interviews.
RESULTS: Thirty-three patients (M = 20) (42 ± 12.7 years) were included in the current analysis. At 1y follow-up, an overall response rate of 70% (23/33) was found for ONS. In total, 48% (18/33) of patients were defined as
voltage tuners.
Voltage tuning was performed with an average increase in amplitude of 92 (20-360)%, a frequency of 1-20 times/month and duration of 20 minutes-48 hours. Sensations of
voltage tuning were described as \"tingling\" and/or \"pinching\". The rationale for voltage tuning in patients varied from prevention and ceasing to lowering the intensity and enhance control of CH attack.
CONCLUSIONS: Outcomes show that voltage tuning may cease and/or terminate CH attacks and therefore raise interests in the use of ONS as acute attack treatment for patients with resistant CH treated with ONS. Future research on the occurrence and potential of voltage tuning will provide valuable insights for achieving optimal efficacy of ONS and quality of life in patients with CH.