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In chronic cluster headache (CH), as opposed to episodic CH, the attacks occur year-round. Chronic CH is also harder to treat, highlighted by recent trials of medications and devices that are effective for only episodic CH. Previous small studies of occipital nerve stimulation have shown promise in CH as a whole, although it is unclear if chronic CH is again an exception.
Here, the authors performed a randomized, double-blind, phase 3 trial of occipital nerve stimulation for the most highly burdened patients: medically intractable chronic CH (defined as failing verapamil, lithium, and one other medication). There was no placebo group because the stimulator causes a noticeable tingling that would unblind the participants. Instead, the 150 par…