Neck Buzzer That Can Soothe Migraines

By ROGER DOBSON

MIGRAINE and painful cluster headaches could be eased by stimulating nerves at the back of the neck.

The technique – where wires carrying electrical impulses are implanted in the neck – is being tested in a number of clinical trials.

Preliminary studies have shown that symptoms in some people can be more than halved.

Most people with migraine are helped by drug treatments, but for some people drugs are not effective. The stimulation therapy is aimed at people who have chronic migraine – headaches on more than 15 days a month which are not helped by existing treatments.

A cluster headache is one of the most painful types. Patients experience a series (or ‘cluster’) of headaches one after another.

This can last for weeks or even months, followed by a remission that may last for years.

There are drugs which can make the headaches shorter and less severe, but these do not work for everyone.

With the new technique, a ‘generator’ is implanted in the patient’s back near the kidneys, or in the chest. Wires or electrodes from the implanted generator are tunnelled under the skin until they are in contact with one or both of the occipital nerves, which are situated on either side of the neck at the base of the skull.

The generator delivers electrical impulses to the nerves.

Exactly how occipital stimulation works to reduce symptoms is not clear, but one theory is that it interferes with pain signals travelling along the nerves.

At least three companies are already working on the idea of using electrical stimulation to treat headaches. One form of stimulation for migraine – deep brain stimulation – involves extensive surgery. Another version, recently tested in a trial at Ohio State University, used transcranial magnetic stimulation (TMS) where a magnetic device is pressed to the back of the head.

Results from a study at the Mayo Clinic in Arizona involving 13 women and three men aged 21 to 52 who had stimulation of both nerves, shows they had an average 54 per cent drop in pain.

Six patients had no change or less than a 50 per cent reduction.

Results from a small trial involving seven patients at the Headache Research Unit of Belgium’s Liege University show significant improvements in patients with chronic cluster headache.

Two patients were pain-free after follow-ups at 16 and 22 months, although another still had occasional attacks. Three of the patients had a reduction in attacks of around 90 per cent, while two had improvements of about 40 per cent. All but one of the patients were able to substantially reduce drug treatment.

The researchers also found that if the stimulator was switched off, the attacks returned within days in all the patients who had improved.

Just when the new treatment could be more widely available is not yet clear. For further information, contact Medronic 019213 212213.

BOTULINUM toxin can be effective in the prevention of chronic daily headaches. The toxin is injected into the scalp.

Results from a new study at the Sapienza University of Rome, based on 1,347 patients, shows that after 12 months, patients were free of attacks 23 days a month.

The researchers say only 1.6per cent of patients reported adverse events, and these were all mild and short-term.

It appears to be an efficacious new treatment choice, especially for patients not responding to previous prophylactic treatments, they say.

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