Technology offers hope for migraine patients

Migraine is a neurological disorder characterised by a number of specific symptoms that can last for hours or days at a time. The severity of each migraine attack can vary widely, with typical symptoms ranging from sensitivity to light, noise and motion, through to nausea and vomiting, in addition to headache. In general, chronic migraine sufferers have progressed to the level where they have migraine or migraine-like symptoms on more days than they are migraine free. Estimates by the World Health Organization (WHO) indicate that 10% of adults worldwide suffer from migraine, and 1.7% to 4% of adults have headaches 15 or more days per month. In fact, WHO ranks migraine as one of the top 20 most disabling conditions in the world, categorising it as the same level of disability as dementia, quadriplegia and acute psychosis. It is also classified as more disabling than blindness, paraplegia angina or rheumatoid arthritis.1 Not only is the condition severely disabling, but it also has a significant impact on the economy as a whole. The cost of migraine (for medication alone) is estimated to be around £150 m per year, in the UK. However, when the 25 million working days that are also lost are included in these calculations, the total cost increases to £2.25 bn per year.2

Treatment options

Treatment options for chronic migraine include a number of drug therapies and, more recently, Botox – which is now licensed by the Medicines and Healthcare products Regulatory Agency (MHRA). Unfortunately, effective management of chronic migraine continues to prove elusive for some individuals and a significant number of patients remain severely disabled by the condition. For those who have reached ‘the end of the line’, there is now another potential treatment that could offer hope in the form of peripheral nerve stimulation (PNS) of the occipital nerve. PNS therapy involves the delivery of mild electrical pulses to the occipital nerves, which are located just beneath the skin at the back of the head. “The surgery is relatively straightforward and is performed by a neurosurgeon under light general anaesthetic,” explained Dr Paul Davies, consultant neurologist, Northampton General Hospital, UK. “An electrode is inserted, by tunneling under the skin, which makes contact with the occipital nerve. This is connected to a small battery pack, located in a comfortable place, such as under the patient’s arm. In simple terms, the system works like a pacemaker or a TENS machine. “Patients retain control of the system at all times, and can turn it up or down – most find it comfortable and, in my experience, no one has expressed regret at having undergone the procedure. Some patients go as far as saying it has ‘given them their life back’. While the results vary between patients, most patients report being satisfied with the results. “Patients undergo a temporary evaluation, or trial, so that they are able to understand what the stimulation feels like before they commit to surgical implant of the system. The procedure is also reversible and physicians can immediately cease treatment by turning off or removing the stimulator. “The procedure is invasive and relatively expensive, so it is usually recommended for the end of the road patient who is significantly disabled. Access to treatment on the NHS is therefore limited – patients have normally been referred via a headache centre, have failed all currently available treatments and, historically, a number have been entered into clinical trials. “Although this is a pioneering surgical approach, interest has accelerated since the publication of clinical trials and CE approval of the technology,” he pointed out. “For the right patient, performed in the right way, by the right people, PNS offers significant promise.”