Brief Answer:
Nerve Stimulation for cluster headaches- Underwhelming Results

Detailed Answer:
Good afternoon. Thank you for your question on this network and I am sorry you need to ask about this particularly painful and obstinate type of headache.

As a headache specialist who runs a large clinic through the VA Hospital in XXXXXXX I've had many occasions to treat cluster patients with and without stimulators and I can answer your question by stating first that there are a couple of options available. One is the OCCIPITAL NERVE stimulator while the other is the VAGAL NERVE stimulator. My experience at the VA Hospital where cluster headaches are one of the top 3-4 types of headaches I deal with on a regular basis I can say that the long term success rate of FULL and permanent relief is poor at best. If on the other hand one looks at the numerous small studies that are published the claims range between 40-60% success.

However, you must keep in mind that in these studies SUCCESS is variably defined. In some research articles they consider success to be a 50% reduction in frequency of headaches whereas other studies look for any reduction of frequency and/or intensity as being the markers of success. Other studies consider "patient satisfaction" scores which can be difficult to ascertain meaning on or how the researchers themselves are even interpreting what patients actually said.

There are reports of untoward effects as well after implantation of attacks of cluster on the opposite side after one side has been implanted as well as other neurological side effects which were not expected such as numbness/tingling and even feelings of unusual or different sorts of attack pains not related to the headaches causing patients enough grief to ask that the unit be removed.

Yes, there are clearly patients who are satisfied with their stimulators and companies are always scrambling to come up with better "mousetraps" for a hungry public who in many cases is open to doing just about anything and spend the money necessary to relieve some of the most difficult and painful types of headache known to man.

But my truthful answer to your question is what I've given.

I've not been overly impressed with results in the majority of patients which takes into consideration overall degree of effectiveness, longevity of relief, unexpected and untoward side effects after implantation, and risks associated with implantation.

On the question of cost I cannot give you accurate numbers because since I am a doctor at the VA it is not something I concern myself with for the most part. If I feel a patient is a candidate and needs to be referred for implantation then, I never really see any type of cost breakdown....that's all "billing office data." Also, the patients at the VA to my knowledge have very little to NO obligations financially for the devices nor the procedure to implant. In the general NONMILITARY public I would say that insurance companies will variably meet financial coverages depending upon the insurer, the policy, and what they perceive to be the medical necessity of getting such a procedure done based upon what the patient has actually received in terms of pharmacological or other therapy or intervention.

If you were planning on covering the entire cost of this type of device and procedure then, I would plan on a minimum of $15-$20K dollars to get implantation fully performed by a qualified surgeon including the cost of the device. But again, that would be a pure guess based on what I know average costs of implantable medical devices run. As a comparator I know that injecting a typical migraine patient during 1 session in the clinic can run $2500-$3000...and those are just a series of injections with a total time of about 30-40 minutes in the office. So imagine what the cost of a stimulator device is which will be implanted by a neurosurgeon?

However, more important to my mind is the consideration of actual effectiveness of these devices in the long run and what YOU as a patient are willing to accept as the parameter that your neurologist or neurosurgeon considers reflective of significant relief of your headaches....make sense?

If you're willing to take a certain percentage reduction in pain and frequency and call that a success then, you may find relief according to what test study subjects report in the literature. If your thought is that this device represents a sure fire cure then, I caution you that only a very very few individuals can claim that sort of outcome compared to the number who have been implanted. Furthermore, I've never seen one of THOSE types of patients come through my clinic in 15 years of running the headache clinic at a very busy, academic medical center which treats thousands of headache patients yearly.

Beware of what others may tell you who may have vested interests in either the equipment, the performance of the procedure, or other at times difficult to identify or discover agendas that cause people to claim remarkable results.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my suggestions have helped? Again, many thanks for posing your question and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 42 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---