• Effectiveness of Pharmacological Treatments in Imploding vs. Exploding Headaches

      Hunt, Megan; The University of Arizona College of Medicine - Phoenix; Files, Julia (The University of Arizona., 2013-03)
      Recent research shows variability in the effectiveness of botulinum toxin A among patients who experience their headaches as imploding compared with those who experience exploding headache sensations. Further research has not yet examined whether such variability exists among other pharmacological treatments. This study examines the effectiveness of acute and preventative medications in imploding vs. exploding headaches. 201 patients were recruited in the Women’s Health Internal Medicine Program at Mayo Clinic. These patients were given surveys to determine their physician identified headache type (imploding, exploding, or ocular), as well as patient-reported information about the effectiveness of prophylactic medications or triptans. This data was analyzed to determine whether a significant difference existed between medications that were effective for imploding, exploding, or ocular headaches. The study found that no such difference existed. The data was also used to analyze the correlation between physician-identified headache type and the patient-identified headache type. There appears to be only a weak correlation between these assignments, suggesting some room for improvement in the way headache directionality is explored by physician and understood by patients. In the future, research will hopefully uncover additional factors which are useful as predictors for migraine pharmacology.
    • Long-Term Outcome in Occipital Nerve Stimulation Patients

      Brewer, Ann Chang; The University of Arizona College of Medicine - Phoenix; Trentman, Terrence (The University of Arizona., 2013-03)
      Objectives and Hypothesis: Occipital nerve stimulation (ONS) may provide relief for refractory headache disorders. However, scant data exist regarding long-term ONS outcomes. We sought to provide long-term data on ONS efficacy in refractory headache disorder. Methods: The methods used were retrospective review of the medical records of all (non-industry study) patients who were trialed and implanted with occipital nerve stimulator systems at our institution, followed by a phone interview. Up to three attempts were made to contact each patient, and those who were contacted were given the opportunity to participate in a brief phone interview regarding their ONS experience. Data for analysis were gleaned from both the phone interview and the patient’s medical records. Results: Twenty-nine patients underwent a trial of ONS during the 8.5-year study period. Three patients did not go on to permanent implant, 12 could not be contacted, and 14 participated in the phone interview. Based upon the phone interview (if the Patient was contacted) or chart review, ONS was deemed successful in five of the 12 migraine, four of the five cluster headache, and five of the eight miscellaneous headache patients, and therapy was documented as long as 102 months. In one of the 26 patients, success of ONS could not be determined. Among patients deemed to have successful outcomes, headache frequency decreased by 18%, severity by 27%, and migraine disability score by 50%. Fifty-eight percent of patients required at least one lead revision. Significance: These results, although limited by their retrospective nature, suggest that ONS can be effective long term despite technical challenges. The number of patients within each headache subtype was insufficient to draw conclusions regarding the differential effect of ONS. Randomized controlled long-term studies in specific, intractable, primary headache disorders are indicated.