New Cluster Headache Treatment Strikes a Good Nerve
Cluster headache is one of the most challenging conditions to treat. A new treatment that involves noninvasive vagus nerve stimulation may offer renewed hope for all those who suffer with this head pain.
What’s different about the new treatment?
If you are familiar with cluster headache, you may already know about a treatment option called vagus nerve stimulation. This approach, which has been available for more than two decades, involves implanting a device that stimulates the vagus nerve.
The vagus nerve runs from the head through the neck down to the abdomen on body sides of the body. To treat cluster headache, a pulse generator is implanted under the skin of the chest and an electrical wire is attached to the vagus nerve.
The battery-powered generator sends electrical signals to the vagus nerve. They in turn are transmitted to the brain to turn off the pain. Although vagus nerve stimulation is successful in some cases of cluster headache, it is an expensive and invasive procedure and therefore not considered a first line of treatment.
The new treatment approach, which is being studied in clinical trials, involves non-invasive vagus nerve stimulation using a handheld device called gammaCore, developed by electroCore. Information about gammaCore was presented at the recent American Headache Society Annual Scottsdale Headache Symposium and the North American Neuromodulation Society meeting.
Clinical trials for cluster headache
Among the four clinical trials underway for cluster headache is “A randomized, multicenter double-blind, parallel, sham-controlled study of GammaCore a non-invasive neurostimulator device for the acute relief of episodic and chronic cluster headache.” The study began recruiting in August 2013, and it is scheduled to be completed by March 2014. The study locations are in Germany, Denmark, the United Kingdom, and the Netherlands.
The study involves treating one group with non-invasive vagus nerve stimulation while the second group is given a sham treatment. After this segment of the study, both groups will receive active treatment. This cluster headache study is being conducted for submission to the Food and Drug Administration for approval.
Among the benefits of the noninvasive vagus nerve stimulation approach is that patients can treat themselves in as little two minutes. The investigators note that the new treatment has thus far proven itself to be well tolerated and to work with other medications. It stimulates the body’s production of certain chemicals that in turn reduces activity of glutamate, a neurotransmitter involved in headache.
Cluster headaches are chronic, repeated episodes of severe one-sided head pain that is often accompanied by a stuffy nose, flushed face, swelling around the eyes, and tearing eyes. Men are four times more likely to experience cluster headache than women.
The cause of cluster headache is not known, but experts believe there is a genetic component. One theory is that a malfunction in the hypothalamus, which is located at the base of the brain, causes spontaneous releases of chemical substances called serotonin or histamine.
What triggers a cluster headache? Candidates include use of alcohol, smoking, hot weather, processed meats (high in nitrites), use of certain medications, high altitudes, bright lights, and cocaine.
Current treatments for cluster headache include oxygen (breathing 100 percent oxygen through a mask), various triptans (e.g., injectable sumatriptan, oral or nasal spray zolmitriptan), octreotide (Sandostatin), intranasal lidocaine, dihydroergotamine (intravenous), occipital nerve stimulation, and deep brain stimulation. As you can see, most of these remedies are not convenient and the latter two require surgery.
The lack of effective treatments for cluster headache make the development of this new noninvasive vagus nerve stimulation approach especially exciting. People who suffer with this painful condition should keep their eyes and ears open for updated information on the clinical trials and talk to their healthcare providers.