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2. Cluster Headache RecommendationsGreat reserve should be taken in the application of interventional pain treatment for cluster headache. The evidence of the different invasive treatment modalities is very limited and of very low or low quality. Several treatments carry the risk for serious adverse events. From a risk benefit point of view, we come to the following overall recommendations:DescriptionStrength of recommendationLevel of evidenceInfiltration with steroids and lignocaine of the greater occipital nerves can be considered for short-term effect in patients with episodic cluster headache.Very weakNot gradedDescriptionStrength of recommendationLevel of evidenceRadiofrequency treatment of the ganglion pterygopalatinum could be considered for long-term effect in patients with episodic and chronic cluster headache.WeakVery lowDescriptionStrength of recommendationLevel of evidenceStimulation of the nervus occipitalis could be considered in patients for the treatment of cluster headache .Very weakVery lowDescriptionStrength of recommendationLevel of evidenceThe implantation of a stimulation device at the ganglion pterygopalatinum to treat cluster headache attacks could be considered.Very weakLowClinical questionWhat is the place for interventional pain treatments in the management algorithm of cluster headache? Researched treatment optionsFor patients with cluster headache the following treatments were investigated.Infiltration with steroids and lignocaine of the nervus occipitalis majorRadiofrequency treatment of the ganglion pterygopalatinum (PPG)Stimulation of ganglion pterygopalatinumOccipital nerve stimulationAny comparators including sham, no treatment or other active treatment techniques were eligible. Inclusion was not restricted based on outcomeMethodsFor the search strategy and the methodology, we refer to the introduction.Results of literature searchNo systematic reviews were published between 2010 and 2015 on the described interventional pain management techniques for the treatment of cluster headache. The following studies were retrieved. RCT on stimulation of the ggl pterygopalatinum ADDIN EN.CITE <EndNote><Cite><Author>Schoenen</Author><Year>2013</Year><RecNum>10971</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>10971</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1397660693">10971</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schoenen, J.</author><author>Jensen, R. H.</author><author>Lanteri-Minet, M.</author><author>Lainez, M. J.</author><author>Gaul, C.</author><author>Goodman, A. M.</author><author>Caparso, A.</author><author>May, A.</author></authors></contributors><auth-address>Headache Research Unit, Department of Neurology, CHR Citadelle, Liege University, B-4000 Liege, Belgium. jschoenen@ulg.ac.be</auth-address><titles><title>Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study</title><secondary-title>Cephalalgia</secondary-title></titles><periodical><full-title>Cephalalgia</full-title></periodical><pages>816-30</pages><volume>33</volume><number>10</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Cluster Headache/physiopathology/*therapy</keyword><keyword>Electric Stimulation Therapy/instrumentation/*methods</keyword><keyword>*Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Ganglia, Parasympathetic/*physiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microelectrodes</keyword><keyword>Middle Aged</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Pterygopalatine Fossa/physiology</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>23314784</accession-num><urls><related-urls><url> study on pulsed radiofrequency treatment of the ggl pterygopalatinum PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaHVhPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj

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ADDIN EN.CITE.DATA 3-6 Infiltration with steroids and lignocaine of the greater occipital nervesLiterature review Infiltration of the n. occipitalis was described to be effective for cervicogenic headache, cluster headache and occipital neuralgia in a narrative review, ADDIN EN.CITE <EndNote><Cite><Author>Tobin</Author><Year>2009</Year><RecNum>4545</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>4545</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">4545</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tobin, J.</author><author>Flitman, S.</author></authors></contributors><auth-address>21st Century Neurology-Neurology, 2601 North Third Street, Phoenix, AZ 85004, USA.</auth-address><titles><title>Occipital nerve blocks: when and what to inject?</title><secondary-title>Headache</secondary-title></titles><periodical><full-title>Headache</full-title></periodical><pages>1521-33</pages><volume>49</volume><number>10</number><edition>2009/08/14</edition><dates><year>2009</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>1526-4610 (Electronic)1526-4610 (Linking)</isbn><accession-num>19674126</accession-num><urls><related-urls><url> [pii]10.1111/j.1526-4610.2009.01493.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>7published at the time of publication of the previous guideline. This review reported on a RCT comparing injection of steroid (betamethasone) and local anesthetic with injection of saline.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbWJyb3Npbmk8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFy

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ADDIN EN.CITE.DATA 8 Eighty five percent of the patients in the steroid + local anesthetic group became pain free compared to none in the saline group. The effect of the steroid + local anesthetic injection lasted 4 weeks in 8/13 patients and 4 months in 5/13 patients. A retrospective study showed pain relief in 45% of the population of patients with refractory cluster headache for the duration of 17 days. ADDIN EN.CITE <EndNote><Cite><Author>Afridi</Author><Year>2006</Year><RecNum>3620</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>3620</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">3620</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Afridi, S. K.</author><author>Shields, K. G.</author><author>Bhola, R.</author><author>Goadsby, P. J.</author></authors></contributors><auth-address>Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.</auth-address><titles><title>Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection</title><secondary-title>Pain</secondary-title></titles><periodical><full-title>Pain</full-title></periodical><pages>126-9</pages><volume>122</volume><number>1-2</number><keywords><keyword>Afferent Pathways/*drug effects</keyword><keyword>Anesthetics, Local/administration & dosage</keyword><keyword>Dose-Response Relationship, Drug</keyword><keyword>Drug Administration Schedule</keyword><keyword>Drug Combinations</keyword><keyword>Headache Disorders, Primary/*therapy</keyword><keyword>Lidocaine/*administration & dosage</keyword><keyword>Longitudinal Studies</keyword><keyword>Methylprednisolone/*administration & dosage</keyword><keyword>Nerve Block/*methods</keyword><keyword>Neuroprotective Agents/administration & dosage</keyword><keyword>Prognosis</keyword><keyword>Syndrome</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2006</year><pub-dates><date>May</date></pub-dates></dates><accession-num>16527404</accession-num><urls><related-urls><url> Other studies described in this review were less specific or used combination with prophylactic treatment.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbnRob255PC9BdXRob3I+PFllYXI+MjAwMDwvWWVhcj48

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ADDIN EN.CITE.DATA 10, 11 This treatment option was not discussed in the previous guideline. ADDIN EN.CITE <EndNote><Cite><Author>van Kleef</Author><Year>2009</Year><RecNum>5520</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>5520</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">5520</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van Kleef, M.</author><author>Lataster, A.</author><author>Narouze, S.</author><author>Mekhail, N.</author><author>Geurts, J. W.</author><author>van Zundert, J.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands. maarten.van.kleef@mumc.nl</auth-address><titles><title>Evidence-based interventional pain medicine according to clinical diagnoses. 2. Cluster headache</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>435-42</pages><volume>9</volume><number>6</number><edition>2009/10/31</edition><keywords><keyword>Analgesics/*therapeutic use</keyword><keyword>Cluster Headache/*diagnosis/*therapy</keyword><keyword>Ergotamines/therapeutic use</keyword><keyword>*Evidence-Based Medicine</keyword><keyword>Humans</keyword><keyword>Oxalates</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Radio Waves</keyword><keyword>Sumatriptan/therapeutic use</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>1533-2500 (Electronic)1530-7085 (Linking)</isbn><accession-num>19874534</accession-num><urls><related-urls><url> [pii]10.1111/j.1533-2500.2009.00331.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>12 Since the publication of the narrative review, one study was published on the use of greater occipital nerve infiltration for the treatment of cluster headache. A retrospective observational study with 60 patients described that infiltration of the greater occipital nerve (GON) with steroids and lignocaine seems to be an effective method to alleviate the pain of cluster headache patients, and especially episodic cluster headache patients.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYW50ZW5iZWluPC9BdXRob3I+PFllYXI+MjAxMjwvWWVh

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ADDIN EN.CITE.DATA 13 Nearly 80% of all infiltrations resulted in at least a partial effect and 43.7% in the complete relief of pain. The effect lasted on average 3.5?weeks. These data suggest that chronic cluster headache patients may benefit more from bilateral infiltration, whereas episodic cluster headache patients may also benefit from ipsilateral infiltration. Systemic side effects are less frequent and less severe with local infiltration of steroids than with oral administration, but they can still be present. Only a few, transient and mild side effects were observed in this patient group.This is evidence of very low quality that GON injections with steroids and lignocaine are effective in episodic cluster headache for on average at least 3.5 weeksConclusions and RecommendationQuality of the evidenceDescriptionNot gradedUnilateral injection of the n. occipitalis major with steroid and lignocaine reduces attack frequency, duration or severity of episodic cluster headache if conventional treatment is not successful, for 3.5 weeks. Gantenbein AR et al. 2012Quality of the evidence DescriptionNot gradedBilateral injection of the n. occipitalis major with steroid and lignocaine reduces attack frequency, duration and severity of episodic and chronic cluster headache if conventional treatment is not successful Gantenbein AR et al. 2012RecommendationStrength of recommendationLevel of evidenceInfiltration with steroids and lignocaine of the nervi occipitales major greater occipital nerves can be considered for short-term effect in patients with episodic cluster headache refractory to conservative treatment.Very weakNot gradedRadiofrequency treatment of the ganglion pterygopalatinum Literature reviewIn the previous guideline, it was recommended to perform RF treatment of the ganglion pterygopalatinum (PPG) (formerly ggl. sphenopalatinum) if conventional treatment is not successful, preferably study related. This recommendation was based on three studies. A retrospective study of 56 patients with episodic and 10 patients with chronic cluster headache which were treated by RF treatment of the PPG had a follow-up period of 12 to 70 months. In the group with episodic cluster headache, 60.7% experienced complete pain relief, while only 3 out of 10 patients with chronic cluster headache had the same result. ADDIN EN.CITE <EndNote><Cite><Author>Sanders</Author><Year>1997</Year><RecNum>161</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>161</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">161</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sanders, M.</author><author>Zuurmond, W. W.</author></authors></contributors><auth-address>Department of Anesthesiology, Spaarne Hospital, Haarlem, The Netherlands.</auth-address><titles><title>Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation</title><secondary-title>J Neurosurg</secondary-title></titles><periodical><full-title>J Neurosurg</full-title></periodical><pages>876-80</pages><volume>87</volume><number>6</number><keywords><keyword>Acute Disease</keyword><keyword>Adult</keyword><keyword>Autonomic Nerve Block/adverse effects/*methods</keyword><keyword>Catheter Ablation/adverse effects</keyword><keyword>Cheek</keyword><keyword>Chronic Disease</keyword><keyword>Cluster Headache/drug therapy/*surgery</keyword><keyword>Epistaxis/etiology</keyword><keyword>Evaluation Studies</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Ganglia, Parasympathetic/*surgery</keyword><keyword>Ganglionectomy/adverse effects</keyword><keyword>Hematoma/etiology</keyword><keyword>Human</keyword><keyword>Hypesthesia/etiology</keyword><keyword>Male</keyword><keyword>Maxillary Nerve/injuries</keyword><keyword>Palate/innervation</keyword><keyword>Remission Induction</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>1997</year><pub-dates><date>Dec</date></pub-dates></dates><accession-num>9384398</accession-num><urls><related-urls><url> The above report showed that RF treatment of the PPG may improve episodic cluster headache but not chronic cluster headache. Narouze et al. also reported favorable outcome after intractable chronic cluster headache. In this retrospective study of 15 patients, they reported significant improvement in both mean attack intensity and mean attack frequency for up to 18 months. ADDIN EN.CITE <EndNote><Cite><Author>Narouze</Author><Year>2009</Year><RecNum>11390</RecNum><DisplayText><style face="superscript">15</style></DisplayText><record><rec-number>11390</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1418116678">11390</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Narouze, S.</author><author>Kapural, L.</author><author>Casanova, J.</author><author>Mekhail, N.</author></authors></contributors><auth-address>Cleveland Clinic Foundation, Pain Management Department, Cleveland, OH 44195, USA.</auth-address><titles><title>Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache</title><secondary-title>Headache</secondary-title><alt-title>Headache</alt-title></titles><periodical><full-title>Headache</full-title></periodical><alt-periodical><full-title>Headache</full-title></alt-periodical><pages>571-7</pages><volume>49</volume><number>4</number><keywords><keyword>Catheter Ablation/*methods</keyword><keyword>Cluster Headache/*pathology/*surgery</keyword><keyword>Follow-Up Studies</keyword><keyword>Ganglia, Parasympathetic/*surgery</keyword><keyword>Ganglionectomy/methods</keyword><keyword>Humans</keyword></keywords><dates><year>2009</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1526-4610 (Electronic)0017-8748 (Linking)</isbn><accession-num>18783451</accession-num><urls><related-urls><url> After RF treatment of the PPG, postoperative epistaxis, bleeding in the jaw and unintentional partial lesion of the nervus maxillaris were observed. 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ADDIN EN.CITE.DATA 15, 16No additional systematic reviews or RCT’s were found since the publication of the previous guideline. ConclusionQuality of the evidence Descriptionvery lowThere is evidence of very low quality that radiofrequency treatment of the ggl. pterygopalatinum reduces intensity and frequency of the cluster headache attacks up to 18 months after the intervention Sanderset al. 1997; Narouze S et al. 2009; Filippini-de Moor G et al. 1999ConsiderationsA new search until end February 2018 showed no new systematic reviews, RCTs or prospecetive trials relevant to the research questionRadiofrequency treatment of the PPG seems to have a clinical relevant effect. This is a neuroablative procedure which may involve serious adverse events. Destruction of the PPG could result in dryness of the eyes. A possible complication is hypoesthesia of the palatum molle, which generally disappears after 6 to 8 weeks. Another complication is nose bleeding and swelling as the result of a hematoma. A bothersome complication is the accidental lesion of the nervus maxillaris, which can occur when the technique is not properly carried out. ADDIN EN.CITE <EndNote><Cite><Author>van Kleef</Author><Year>2009</Year><RecNum>5520</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>5520</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">5520</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van Kleef, M.</author><author>Lataster, A.</author><author>Narouze, S.</author><author>Mekhail, N.</author><author>Geurts, J. W.</author><author>van Zundert, J.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands. maarten.van.kleef@mumc.nl</auth-address><titles><title>Evidence-based interventional pain medicine according to clinical diagnoses. 2. Cluster headache</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>435-42</pages><volume>9</volume><number>6</number><edition>2009/10/31</edition><keywords><keyword>Analgesics/*therapeutic use</keyword><keyword>Cluster Headache/*diagnosis/*therapy</keyword><keyword>Ergotamines/therapeutic use</keyword><keyword>*Evidence-Based Medicine</keyword><keyword>Humans</keyword><keyword>Oxalates</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Radio Waves</keyword><keyword>Sumatriptan/therapeutic use</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>1533-2500 (Electronic)1530-7085 (Linking)</isbn><accession-num>19874534</accession-num><urls><related-urls><url> [pii]10.1111/j.1533-2500.2009.00331.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>12 However, in experienced hands, the RF treatment only aims at a partial lesion of the ganglion. RF treatment of the PPG should only be performed in patients who have been treated conservatively without satisfactory outcome and after having obtained informed consent based on a shared decision. This treatment should be reserved for specialized pain centers with sufficient experience in these kinds of procedures. Because of the relatively low complication rate, and the minimal invasiveness compared to neurostimulation and value and preference of the guideline development group the recommendation was upgraded from very weak to weak.The effect of radiofrequency treatment of the ganglion pterygopalatinum should be assessed in further studies.RecommendationDescriptionStrength of recommendationLevel of evidenceRadiofrequency treatment of the ganglion pterygopalatinum could be used for long-term effect in patients with episodic and chronic cluster headache refractory to conservative treatment. WeakVery lowStimulation of ganglion pterygopalatinumLiterature overviewThe previous guideline discussed neurostimulation for the management of cluster headache. ADDIN EN.CITE <EndNote><Cite><Author>van Kleef</Author><Year>2009</Year><RecNum>5520</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>5520</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">5520</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van Kleef, M.</author><author>Lataster, A.</author><author>Narouze, S.</author><author>Mekhail, N.</author><author>Geurts, J. W.</author><author>van Zundert, J.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands. maarten.van.kleef@mumc.nl</auth-address><titles><title>Evidence-based interventional pain medicine according to clinical diagnoses. 2. Cluster headache</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>435-42</pages><volume>9</volume><number>6</number><edition>2009/10/31</edition><keywords><keyword>Analgesics/*therapeutic use</keyword><keyword>Cluster Headache/*diagnosis/*therapy</keyword><keyword>Ergotamines/therapeutic use</keyword><keyword>*Evidence-Based Medicine</keyword><keyword>Humans</keyword><keyword>Oxalates</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Radio Waves</keyword><keyword>Sumatriptan/therapeutic use</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>1533-2500 (Electronic)1530-7085 (Linking)</isbn><accession-num>19874534</accession-num><urls><related-urls><url> [pii]10.1111/j.1533-2500.2009.00331.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>12 The stimulation of the ganglion pterygopalatinum was not discussed. The first proof of evidence study was only published in 2010. ADDIN EN.CITE <EndNote><Cite><Author>Ansarinia</Author><Year>2010</Year><RecNum>10993</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>10993</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1398445200">10993</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ansarinia, M.</author><author>Rezai, A.</author><author>Tepper, S. J.</author><author>Steiner, C. P.</author><author>Stump, J.</author><author>Stanton-Hicks, M.</author><author>Machado, A.</author><author>Narouze, S.</author></authors></contributors><auth-address>The Headache Specialists, Las Vegas, NV, USA.</auth-address><titles><title>Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches</title><secondary-title>Headache</secondary-title></titles><periodical><full-title>Headache</full-title></periodical><pages>1164-74</pages><volume>50</volume><number>7</number><keywords><keyword>Adult</keyword><keyword>Cluster Headache/etiology/physiopathology/*therapy</keyword><keyword>Electric Stimulation Therapy/adverse effects/*methods</keyword><keyword>Facial Neuralgia/etiology/physiopathology/*therapy</keyword><keyword>Female</keyword><keyword>Ganglia, Parasympathetic/anatomy & histology/radiography/surgery</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Pterygopalatine Fossa/anatomy & histology/radiography/surgery</keyword><keyword>Young Adult</keyword></keywords><dates><year>2010</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>20438584</accession-num><urls><related-urls><url> An RCT with an implantable on-demand stimulation of the ggl.pterygoplatinum. Each attack was randomly treated with full, sub-perception or sham stimulation. 32 patients with a baseline average of 19.2 cluster headaches a week, pain relief was achieved in 67.1% of full stimulation-treated attacks at 15 minutes compared to 7.4% in the sham condition and 7.3% in the sub-perception condition. Nineteen of 28 (68%) of patients experienced a clinically significant improvement (frequency of attacks decreases ≥ 50 % and/or pain relief with stimulation). This is an observational result (randomization was per attack, so all patients were intervention patients, no controls). Although five device or procedure-related serious adverse events occurred, the authors considered the overall adverse event profile to be similar to other, comparable, surgical procedures. ADDIN EN.CITE <EndNote><Cite><Author>Schoenen</Author><Year>2013</Year><RecNum>10971</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>10971</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1397660693">10971</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schoenen, J.</author><author>Jensen, R. H.</author><author>Lanteri-Minet, M.</author><author>Lainez, M. J.</author><author>Gaul, C.</author><author>Goodman, A. M.</author><author>Caparso, A.</author><author>May, A.</author></authors></contributors><auth-address>Headache Research Unit, Department of Neurology, CHR Citadelle, Liege University, B-4000 Liege, Belgium. jschoenen@ulg.ac.be</auth-address><titles><title>Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study</title><secondary-title>Cephalalgia</secondary-title></titles><periodical><full-title>Cephalalgia</full-title></periodical><pages>816-30</pages><volume>33</volume><number>10</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Cluster Headache/physiopathology/*therapy</keyword><keyword>Electric Stimulation Therapy/instrumentation/*methods</keyword><keyword>*Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Ganglia, Parasympathetic/*physiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microelectrodes</keyword><keyword>Middle Aged</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Pterygopalatine Fossa/physiology</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>23314784</accession-num><urls><related-urls><url> of the evidenceDescriptionlowThere is evidence of low quality that stimulation of the pterygopalatine ganglion effectively treats attacks of cluster headache.Schoenen J et al. 2013ConsiderationAn open label 24 month follow-up study found clinically relevant reduction of attack frequency in a third of disabled patients for whom medical treatments fail, are not tolerated or are inconvenient for the patients. 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ADDIN EN.CITE.DATA 18The American headache society published in 2016 its evidence based guidelines for the treatment of cluster headache. As in the previous guideline attention is paid to the subdivision: abortive, preventive and chronic treatment. These guidelines stated that the fact that the patient can initiate the stimulation through a hand held programming device, offers the possibility to use stimulation of the PPG as abortive treatment for attacks of cluster headache. ADDIN EN.CITE <EndNote><Cite><Author>Robbins</Author><Year>2016</Year><RecNum>12101</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>12101</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1474558741">12101</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Robbins, M. S.</author><author>Starling, A. J.</author><author>Pringsheim, T. M.</author><author>Becker, W. J.</author><author>Schwedt, T. J.</author></authors></contributors><auth-address>Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA.Mayo Clinic, Phoenix, AZ, USA.University of Calgary, Calgary, Alberta, Canada.</auth-address><titles><title>Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines</title><secondary-title>Headache</secondary-title></titles><periodical><full-title>Headache</full-title></periodical><pages>1093-106</pages><volume>56</volume><number>7</number><keywords><keyword>calcium-channel blockers</keyword><keyword>chronic</keyword><keyword>cluster</keyword><keyword>episodic</keyword><keyword>evidence-based medicine</keyword><keyword>guidelines</keyword><keyword>headache</keyword><keyword>lithium</keyword><keyword>neurostimulation</keyword><keyword>oxygen</keyword><keyword>sphenopalatine</keyword><keyword>verapamil</keyword></keywords><dates><year>2016</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1526-4610 (Electronic)0017-8748 (Linking)</isbn><accession-num>27432623</accession-num><urls><related-urls><url> model-based projection of the cost-effectiveness of stimulation of the PPG through 5 years, found the stimulation to be either cost-effective or cost-saving under the assumption of sustained therapy effectiveness. ADDIN EN.CITE <EndNote><Cite><Author>Pietzsch</Author><Year>2015</Year><RecNum>12102</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>12102</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1474558953">12102</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pietzsch, J. B.</author><author>Garner, A.</author><author>Gaul, C.</author><author>May, A.</author></authors></contributors><auth-address>Wing Tech Inc., Menlo Park, CA, USA, jpietzsch@wing-.</auth-address><titles><title>Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study</title><secondary-title>J Headache Pain</secondary-title></titles><periodical><full-title>J Headache Pain</full-title></periodical><pages>530</pages><volume>16</volume><keywords><keyword>Adult</keyword><keyword>Cluster Headache/*therapy</keyword><keyword>*Cost-Benefit Analysis</keyword><keyword>Electric Stimulation Therapy/*methods</keyword><keyword>Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>*Ganglia, Parasympathetic</keyword><keyword>*Health Care Costs</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Pterygopalatine Fossa/innervation</keyword><keyword>Quality-Adjusted Life Years</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2015</year></dates><isbn>1129-2377 (Electronic)1129-2369 (Linking)</isbn><accession-num>26002638</accession-num><urls><related-urls><url> However, the sustained effectiveness still needs to be demonstrated.The analysis of the patients’ information found that 1/3 of the patients experienced at least one period of complete attack remission and the ability to treat attacks after the period of remission remained the same. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXJsb2VzZTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+

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ADDIN EN.CITE.DATA 21Stimulation of the PPG seems to have a clinical relevant abortive effect of cluster headache attacks ADDIN EN.CITE <EndNote><Cite><Author>Schoenen</Author><Year>2013</Year><RecNum>10971</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>10971</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1397660693">10971</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schoenen, J.</author><author>Jensen, R. H.</author><author>Lanteri-Minet, M.</author><author>Lainez, M. J.</author><author>Gaul, C.</author><author>Goodman, A. M.</author><author>Caparso, A.</author><author>May, A.</author></authors></contributors><auth-address>Headache Research Unit, Department of Neurology, CHR Citadelle, Liege University, B-4000 Liege, Belgium. jschoenen@ulg.ac.be</auth-address><titles><title>Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study</title><secondary-title>Cephalalgia</secondary-title></titles><periodical><full-title>Cephalalgia</full-title></periodical><pages>816-30</pages><volume>33</volume><number>10</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Cluster Headache/physiopathology/*therapy</keyword><keyword>Electric Stimulation Therapy/instrumentation/*methods</keyword><keyword>*Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Ganglia, Parasympathetic/*physiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microelectrodes</keyword><keyword>Middle Aged</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Pterygopalatine Fossa/physiology</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>23314784</accession-num><urls><related-urls><url> Serious adverse events are frequently described. ADDIN EN.CITE <EndNote><Cite><Author>Schoenen</Author><Year>2013</Year><RecNum>10971</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>10971</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1397660693">10971</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schoenen, J.</author><author>Jensen, R. H.</author><author>Lanteri-Minet, M.</author><author>Lainez, M. J.</author><author>Gaul, C.</author><author>Goodman, A. M.</author><author>Caparso, A.</author><author>May, A.</author></authors></contributors><auth-address>Headache Research Unit, Department of Neurology, CHR Citadelle, Liege University, B-4000 Liege, Belgium. jschoenen@ulg.ac.be</auth-address><titles><title>Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study</title><secondary-title>Cephalalgia</secondary-title></titles><periodical><full-title>Cephalalgia</full-title></periodical><pages>816-30</pages><volume>33</volume><number>10</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Cluster Headache/physiopathology/*therapy</keyword><keyword>Electric Stimulation Therapy/instrumentation/*methods</keyword><keyword>*Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Ganglia, Parasympathetic/*physiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microelectrodes</keyword><keyword>Middle Aged</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Pterygopalatine Fossa/physiology</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>23314784</accession-num><urls><related-urls><url> The most important adverse events are device or procedure related, requiring lead revisions and/or PPG neurostimulation explant. These revisions may be due to misplacement of the lead within fossa pterygopalatinum during the original implantation or lead placement within the sinus maxillaris. An early case of lead migration superiorly and laterally, near the region of the nervus maxillaris lead to dysesthesias in the facial and oral territory of the nervus maxillaris, which resolved partly after explantation.Cranial nerve exams revealed sensory disturbance in 81% of patients (35% of peri-operative AEs) with localized loss of sensation in distinct distributions of nervus maxillaris being the most common (21 of 32 events, occurring in 19 of 32 patients). ADDIN EN.CITE <EndNote><Cite><Author>Schoenen</Author><Year>2013</Year><RecNum>10971</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>10971</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1397660693">10971</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schoenen, J.</author><author>Jensen, R. H.</author><author>Lanteri-Minet, M.</author><author>Lainez, M. J.</author><author>Gaul, C.</author><author>Goodman, A. M.</author><author>Caparso, A.</author><author>May, A.</author></authors></contributors><auth-address>Headache Research Unit, Department of Neurology, CHR Citadelle, Liege University, B-4000 Liege, Belgium. jschoenen@ulg.ac.be</auth-address><titles><title>Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study</title><secondary-title>Cephalalgia</secondary-title></titles><periodical><full-title>Cephalalgia</full-title></periodical><pages>816-30</pages><volume>33</volume><number>10</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Cluster Headache/physiopathology/*therapy</keyword><keyword>Electric Stimulation Therapy/instrumentation/*methods</keyword><keyword>*Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Ganglia, Parasympathetic/*physiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microelectrodes</keyword><keyword>Middle Aged</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Pterygopalatine Fossa/physiology</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>23314784</accession-num><urls><related-urls><url> The majority resolved after an average time of 97 days (range: 31–259 days). Some did not resolve but were reported to be mild or moderate.Infections at the incision site and in the ipsilateral sinus maxillaris resolved with antibiotic therapy.Mild paresis of the muscles around the nasolabial fold was reported. ADDIN EN.CITE <EndNote><Cite><Author>Schoenen</Author><Year>2013</Year><RecNum>10971</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>10971</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1397660693">10971</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schoenen, J.</author><author>Jensen, R. H.</author><author>Lanteri-Minet, M.</author><author>Lainez, M. J.</author><author>Gaul, C.</author><author>Goodman, A. M.</author><author>Caparso, A.</author><author>May, A.</author></authors></contributors><auth-address>Headache Research Unit, Department of Neurology, CHR Citadelle, Liege University, B-4000 Liege, Belgium. jschoenen@ulg.ac.be</auth-address><titles><title>Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study</title><secondary-title>Cephalalgia</secondary-title></titles><periodical><full-title>Cephalalgia</full-title></periodical><pages>816-30</pages><volume>33</volume><number>10</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Cluster Headache/physiopathology/*therapy</keyword><keyword>Electric Stimulation Therapy/instrumentation/*methods</keyword><keyword>*Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Ganglia, Parasympathetic/*physiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microelectrodes</keyword><keyword>Middle Aged</keyword><keyword>Pain Measurement/*methods</keyword><keyword>Pterygopalatine Fossa/physiology</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>23314784</accession-num><urls><related-urls><url> Sinus maxillaris puncture during the initial implantation or lead revision procedure did not result in adverse clinical sequelae.This treatment should only be performed after having obtained informed consent based on a shared decision.Stimulation of the PPF should be reserved for specialized pain centers with sufficient experience in these kind of procedures, preferably study related. Recommendations DescriptionStrength of recommendationLevel of evidenceThe implantation of a stimulation device at the ganglion pterygopalatinum to treat cluster headache attacks could be considered.Very weakLowOccipital Nerve StimulationLiterature reviewThe recommendations of the previous guideline were based on case series PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWdpczwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJl

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ADDIN EN.CITE.DATA 22-25 and 1 systematic review of occipital nerve stimulation (ONS) for chronic headache (including cluster headache). ADDIN EN.CITE <EndNote><Cite><Author>Jasper</Author><Year>2008</Year><RecNum>7531</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>7531</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">7531</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jasper, J. F.</author><author>Hayek, S. M.</author></authors></contributors><auth-address>Advanced Pain Medicine Physicians, Tacoma, WA, USA. apmedicine@</auth-address><titles><title>Implanted occipital nerve stimulators</title><secondary-title>Pain Physician</secondary-title></titles><periodical><full-title>Pain Physician</full-title></periodical><pages>187-200</pages><volume>11</volume><number>2</number><edition>2008/03/21</edition><keywords><keyword>Databases, Factual/statistics & numerical data</keyword><keyword>Electric Stimulation Therapy/*methods</keyword><keyword>Headache/*therapy</keyword><keyword>Humans</keyword><keyword>*Spinal Nerves/physiopathology</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar-Apr</date></pub-dates></dates><isbn>1533-3159 (Print)1533-3159 (Linking)</isbn><accession-num>18354711</accession-num><urls><related-urls><url> This treatment appears to mainly decrease the intensity of the attacks. Noticeably, there is a relatively long (2 months or more) period of latency between the implantation of the electrode and a clinical effect.In the recent search four case series on the treatment of cluster headache with peripheral nerve stimulation were identified. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZSBRdWludGFuYS1TY2htaWR0PC9BdXRob3I+PFllYXI+

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ADDIN EN.CITE.DATA 3-5, 27In a case series of 4 patients, there was a 56% (range: 25-95%) reduction in the frequency, a 48.8% (range: 20-60%) decrease in the intensity and a 63.8% (range: 0-88.8%) reduction in the duration of the attacks 6 months after the implantation. ADDIN EN.CITE <EndNote><Cite><Author>de Quintana-Schmidt</Author><Year>2010</Year><RecNum>12097</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>12097</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1474533469">12097</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>de Quintana-Schmidt, C.</author><author>Casajuana-Garreta, E.</author><author>Molet-Teixido, J.</author><author>Garcia-Bach, M.</author><author>Roig, C.</author><author>Clavel-Laria, P.</author><author>Rodriguez-Rodriguez, R.</author><author>Oliver-Abadal, B.</author><author>Bartumeus-Jene, F.</author></authors></contributors><auth-address>Servicio de Neurocirugia, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Espana. cquintana@santpau.es</auth-address><titles><title>[Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache]</title><secondary-title>Rev Neurol</secondary-title></titles><periodical><full-title>Rev Neurol</full-title></periodical><pages>19-26</pages><volume>51</volume><number>1</number><keywords><keyword>Adult</keyword><keyword>Cluster Headache/*surgery</keyword><keyword>Electric Stimulation Therapy/*methods</keyword><keyword>Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Occipital Lobe/*anatomy & histology</keyword><keyword>Peripheral Nerves/*physiopathology</keyword><keyword>Prospective Studies</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2010</year><pub-dates><date>Jul 1</date></pub-dates></dates><orig-pub>Estimulacion del nervio occipital para la cefalea en racimos refractaria al tratamiento farmacologico.</orig-pub><isbn>1576-6578 (Electronic)0210-0010 (Linking)</isbn><accession-num>20568064</accession-num><urls><related-urls><url> All patients showed a 15.4% (range: 6-31.5%) improvement in their quality of life based on SF-36. In all cases but one there was a significant reduction in the amount and dosage of medication required. Postoperative complications were not observed. All patients would recommend the procedure.ConclusionQuality of the evidence DescriptionVery lowThere is evidence of very low quality that stimulation of the occipital nerve is effective in cluster headache, in reducing intensity and duration of the attacksde Quintana-Schmidt C et al. 2010; Magis D et al. 2011; Mueller OM et al 2011; Fontaine D et al. 2011ConsiderationsA new search until end February 2018 showed no new systematic reviews, RCTs or prospecetive trials relevant to the research question.Stimulation of the n. occipitalis seems to have a clinical relevant effect. This procedure is non-neuroablative. Local infection requiring removal of the implant was reported. The major technical problems were battery deplation. In 5 out of 14 patients a side shift with contralateral attacks occurring infrequently or in shourt bouts, and/or isolated ipsilateral autonomic attacks without pain were reported. Some patients experience paresthesia due to the stimulation. There is a report on re-operation due to scar tissue formation around the thoracic connector.A case report mentions the combined stimulation of the n. occipitalis and the nervi supraorbitalis and infraorbitalis and found persistent efficacy over 3 years. ADDIN EN.CITE <EndNote><Cite><Author>Mammis</Author><Year>2011</Year><RecNum>12106</RecNum><DisplayText><style face="superscript">28</style></DisplayText><record><rec-number>12106</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1474561086">12106</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mammis, A.</author><author>Gudesblatt, M.</author><author>Mogilner, A. Y.</author></authors></contributors><auth-address>Department of Neurosurgery, Cushing Neuroscience Institutes, Hofstra University School of Medicine and North Shore University Hospital, Manhasset, New York, USA.</auth-address><titles><title>Peripheral neurostimulation for the treatment of refractory cluster headache, long-term follow-up: case report</title><secondary-title>Neuromodulation</secondary-title></titles><periodical><full-title>Neuromodulation</full-title></periodical><pages>432-5; discussion 435</pages><volume>14</volume><number>5</number><keywords><keyword>Adolescent</keyword><keyword>Cluster Headache/*therapy</keyword><keyword>Electric Stimulation Therapy/instrumentation/*methods</keyword><keyword>Electrodes, Implanted</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Peripheral Nerves/*physiology</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2011</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>1525-1403 (Electronic)1094-7159 (Linking)</isbn><accession-num>21854497</accession-num><urls><related-urls><url> The latter is a report of an experimental setting that needs further study. A RCT is currently being performed and will provide much needed evidence on the role of this treatment. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XaWxicmluazwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+

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ADDIN EN.CITE.DATA 29RecommendationsDescriptionStrength of recommendationLevel of evidenceStimulation of the nervus occipitalis could be considered for the treatment of cluster headache. Very weakVery lowREFERENCES ADDIN EN.REFLIST 1Schoenen J, Jensen RH, Lanteri-Minet M, et al. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia. 2013;33:816-830.2Chua NH, Vissers KC, Wilder-Smith OH. Quantitative sensory testing may predict response to sphenopalatine ganglion pulsed radiofrequency treatment in cluster headaches: a case series. Pain Pract. 2011;11:439-445.3de Quintana-Schmidt C, Casajuana-Garreta E, Molet-Teixido J, et al. [Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache]. Rev Neurol. 2010;51:19-26.4Magis D, Gerardy PY, Remacle JM, et al. Sustained effectiveness of occipital nerve stimulation in drug-resistant chronic cluster headache. Headache. 2011;51:1191-1201.5Mueller OM, Gaul C, Katsarava Z, et al. Occipital nerve stimulation for the treatment of chronic cluster headache - lessons learned from 18 months experience. Central European neurosurgery. 2011;72:84-89.6Muller OM GC, Katsarava Z, Sure U, Diener HC, Gasser T. Bilateral occipital nerve stimulation for the treatment of chronic cluster headache: case series and initiation of a prospective study. Forthschr Neurol Psychiatr. 2010;78:709-714.7Tobin J, Flitman S. Occipital nerve blocks: when and what to inject? Headache. 2009;49:1521-1533.8Ambrosini A, Vandenheede M, Rossi P, et al. Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain. 2005;118:92-96.9Afridi SK, Shields KG, Bhola R, et al. Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection. Pain. 2006;122:126-129.10Anthony M. Cervicogenic headache: prevalence and response to local steroid therapy. Clin Exp Rheumatol. 2000;18:S59-64.11Busch V, Jakob W, Juergens T, et al. Occipital nerve blockade in chronic cluster headache patients and functional connectivity between trigeminal and occipital nerves. Cephalalgia. 2007;27:1206-1214.12van Kleef M, Lataster A, Narouze S, et al. Evidence-based interventional pain medicine according to clinical diagnoses. 2. Cluster headache. Pain Pract. 2009;9:435-442.13Gantenbein AR, Lutz NJ, Riederer F, et al. Efficacy and safety of 121 injections of the greater occipital nerve in episodic and chronic cluster headache. Cephalalgia. 2012;32:630-634.14Sanders M, Zuurmond WW. Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg. 1997;87:876-880.15Narouze S, Kapural L, Casanova J, et al. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. 2009;49:571-577.16Filippini-de Moor G, Barendse G, Van Kleef M, et al. Retrospective analysis of radiofrequency lesions of the sphenopalatine ganglion in the treatment of 19 cluster headache patients. The Pain Clinic. 1999;11:285-292.17Ansarinia M, Rezai A, Tepper SJ, et al. Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches. Headache. 2010;50:1164-1174.18Jurgens TP, Barloese M, May A, et al. Long-term effectiveness of sphenopalatine ganglion stimulation for cluster headache. Cephalalgia. 2017;37:423-434.19Robbins MS, Starling AJ, Pringsheim TM, et al. Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache. 2016;56:1093-1106.20Pietzsch JB, Garner A, Gaul C, et al. Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study. J Headache Pain. 2015;16:530.21Barloese MC, Jurgens TP, May A, et al. Cluster headache attack remission with sphenopalatine ganglion stimulation: experiences in chronic cluster headache patients through 24 months. J Headache Pain. 2016;17:67.22Magis D, Allena M, Bolla M, et al. Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol. 2007;6:314-321.23Schwedt TJ, Dodick DW, Trentman TL, et al. Occipital nerve stimulation for chronic cluster headache and hemicrania continua: pain relief and persistence of autonomic features. Cephalalgia. 2006;26:1025-1027.24Burns B, Watkins L, Goadsby PJ. Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet. 2007;369:1099-1106.25Burns B, Watkins L, Goadsby PJ. Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients. Neurology. 2009;72:341-345.26Jasper JF, Hayek SM. Implanted occipital nerve stimulators. Pain Physician. 2008;11:187-200.27Fontaine D, Christophe Sol J, Raoul S, et al. Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation. Cephalalgia. 2011;31:1101-1105.28Mammis A, Gudesblatt M, Mogilner AY. Peripheral neurostimulation for the treatment of refractory cluster headache, long-term follow-up: case report. Neuromodulation. 2011;14:432-435; discussion 435.29Wilbrink LA, Teernstra OP, Haan J, et al. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study: rationale and protocol of a randomised trial. Cephalalgia. 2013;33:1238-1247. ................
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