In October last year the NHS published a report looking into the possibility of commissioning Occipital Nerve Stimulation as a treatment that can be used to help adult sufferers of intractable chronic migraines (headaches lasting for 4 hours or more per day in 15 or more days per month) and chronic cluster headaches (headaches that last between 15 minutes and 3 hours that occur from once every other day to eight times a day for a year or more). The aim of the report was to conclude whether it could be a viable alternative for patients who do not respond to other existing therapies.
Occipital Nerve Stimulation is a relatively new migraine treatment, first used to treat migraines by St Jude Medical Inc in 2011 – although ONS as a treatment for other conditions was available in the early 1960s. ONS involves a battery-powered pulse generator being implanted beneath the skin and connected with the occipital nerve at the back of the head. Pulse programmes can then be set up with variables such as intensity of pulses, their frequency and their length being adjusted to suit each person’s need. Extra stimulation can also be triggered as and when required, or the generator can also be turned off. The battery lasts on average about six years and can be replaced under local anesthetic.
First the NHS evaluated its past success rates. Trials and reports looking into its efficacy are still limited and the best data is gathered from studies that only had small sample sizes. However it was concluded that the 30% or more reduction for those suffering from chronic migraine, as reported by Silberstein’s et al 2012 data, was enough to warrant it as an effective option.
Although not a cheap path to follow in terms of initial cost the NHS also decided that the longer term patient saving was enough to make it viable. In Germany the cost per patient was € 28,186, but the overall saving as a result of needing less triptans was € 1,603. In the UK there is also unpublished data that shows that chronic cluster headache sufferers who had ONS took 38 fewer does of triptans per month and this equated to a saving of £760 per patient per month. In the long term therefore ONS might also be a good option in terms of cost as well as in terms of best results.
The final conclusion was that ONS should be prescribed to adult patients who met either criteria A or criteria B.
A: The patient must be confirmed as having chronic migraines and have evidence of failure to find significant relief using 4-5 oral medications, acupuncture and Botox.
B: Patients must be confirmed as having chronic cluster headaches for at least two years and have evidence of failure to find significant relief using the usual seven options of oral treatment (e.g. lithium and melatonin).
So the good news, even if you don’t fulfill the criteria for Occipital Nerve Stimulation, is that this report shows that new treatments are continually being added to the list of things that the NHS can offer to migraine sufferers. If nothing’s worked yet, that doesn’t mean that there won’t be something on offer in the future that will.
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