Occipital nerve stimulation for chronic migraine - a systematic review and meta-analysis

Research output: Contribution to journalArticle

Standard

Occipital nerve stimulation for chronic migraine - a systematic review and meta-analysis. / Chen, Yen-Fu; Bramley, George; Unwin, Gemma; Hanu-cernat, Dalvina; Dretzke, Janine; Moore, David; Bayliss, Susan; Cummins, Carole; Lilford, Richard.

In: PLoS ONE, Vol. 10, No. 3, e0116786, 20.03.2015.

Research output: Contribution to journalArticle

Harvard

APA

Vancouver

Author

Bibtex

@article{7d1229c6aa234d6085e07b4148e86199,
title = "Occipital nerve stimulation for chronic migraine - a systematic review and meta-analysis",
abstract = "BackgroundChronic migraine is a debilitating headache disorder that has significant impact on quality of life. Stimulation of peripheral nerves is increasingly being used to treat chronic refractory pain including headache disorders. This systematic review examines the effectiveness and adverse effects of occipital nerve stimulation (ONS) for chronic migraine.MethodsDatabases, including the Cochrane Library, MEDLINE, EMBASE, CINAHL and clinical trial registers were searched to September 2014. Randomized controlled trials (RCTs), other controlled and uncontrolled observational studies and case series (n≥ 10) were eligible. RCTs were assessed using the Cochrane risk of bias tool. Meta-analysis was carried out using a random-effects model. Findings are presented in summary tables and forest plots.ResultsFive RCTs (total n=402) and seven case series (total n=115) met the inclusion criteria. Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95{\%} CI 0.91 to 4.27, I2=0{\%}) of prolonged, moderate to severe headache per month at 3 months compared with a sham control. Results for other outcomes generally favour ONS over sham controls but quantitative analysis was hampered by incomplete publication and reporting of trial data. Lead migration and infections are common and often require revision surgery. Open-label follow-up of RCTs and case series suggest long-term effectiveness can be maintained in some patients but evidence is limited.ConclusionsWhile the effectiveness of ONS compared to sham control has been shown in multiple RCTs, the average effect size is modest and may be exaggerated by bias as achieving effective blinding remains a methodological challenge. Further measures to reduce the risk of adverse events and revision surgery are needed.Systematic Review Registrationthis systematic review is an update and expanded work of part of a broader review registered with PROSPERO. Registration No. CRD42012002633.",
keywords = "Migraine, Headaches, Case series, Adverse events, Randomized controlled trials, Prisms, Surgical and invasive medical procedures, Systematic reviews",
author = "Yen-Fu Chen and George Bramley and Gemma Unwin and Dalvina Hanu-cernat and Janine Dretzke and David Moore and Susan Bayliss and Carole Cummins and Richard Lilford",
year = "2015",
month = "3",
day = "20",
doi = "10.1371/journal.pone.0116786",
language = "English",
volume = "10",
journal = "PLoSONE",
issn = "1932-6203",
publisher = "Public Library of Science (PLOS)",
number = "3",

}

RIS

TY - JOUR

T1 - Occipital nerve stimulation for chronic migraine - a systematic review and meta-analysis

AU - Chen, Yen-Fu

AU - Bramley, George

AU - Unwin, Gemma

AU - Hanu-cernat, Dalvina

AU - Dretzke, Janine

AU - Moore, David

AU - Bayliss, Susan

AU - Cummins, Carole

AU - Lilford, Richard

PY - 2015/3/20

Y1 - 2015/3/20

N2 - BackgroundChronic migraine is a debilitating headache disorder that has significant impact on quality of life. Stimulation of peripheral nerves is increasingly being used to treat chronic refractory pain including headache disorders. This systematic review examines the effectiveness and adverse effects of occipital nerve stimulation (ONS) for chronic migraine.MethodsDatabases, including the Cochrane Library, MEDLINE, EMBASE, CINAHL and clinical trial registers were searched to September 2014. Randomized controlled trials (RCTs), other controlled and uncontrolled observational studies and case series (n≥ 10) were eligible. RCTs were assessed using the Cochrane risk of bias tool. Meta-analysis was carried out using a random-effects model. Findings are presented in summary tables and forest plots.ResultsFive RCTs (total n=402) and seven case series (total n=115) met the inclusion criteria. Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95% CI 0.91 to 4.27, I2=0%) of prolonged, moderate to severe headache per month at 3 months compared with a sham control. Results for other outcomes generally favour ONS over sham controls but quantitative analysis was hampered by incomplete publication and reporting of trial data. Lead migration and infections are common and often require revision surgery. Open-label follow-up of RCTs and case series suggest long-term effectiveness can be maintained in some patients but evidence is limited.ConclusionsWhile the effectiveness of ONS compared to sham control has been shown in multiple RCTs, the average effect size is modest and may be exaggerated by bias as achieving effective blinding remains a methodological challenge. Further measures to reduce the risk of adverse events and revision surgery are needed.Systematic Review Registrationthis systematic review is an update and expanded work of part of a broader review registered with PROSPERO. Registration No. CRD42012002633.

AB - BackgroundChronic migraine is a debilitating headache disorder that has significant impact on quality of life. Stimulation of peripheral nerves is increasingly being used to treat chronic refractory pain including headache disorders. This systematic review examines the effectiveness and adverse effects of occipital nerve stimulation (ONS) for chronic migraine.MethodsDatabases, including the Cochrane Library, MEDLINE, EMBASE, CINAHL and clinical trial registers were searched to September 2014. Randomized controlled trials (RCTs), other controlled and uncontrolled observational studies and case series (n≥ 10) were eligible. RCTs were assessed using the Cochrane risk of bias tool. Meta-analysis was carried out using a random-effects model. Findings are presented in summary tables and forest plots.ResultsFive RCTs (total n=402) and seven case series (total n=115) met the inclusion criteria. Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95% CI 0.91 to 4.27, I2=0%) of prolonged, moderate to severe headache per month at 3 months compared with a sham control. Results for other outcomes generally favour ONS over sham controls but quantitative analysis was hampered by incomplete publication and reporting of trial data. Lead migration and infections are common and often require revision surgery. Open-label follow-up of RCTs and case series suggest long-term effectiveness can be maintained in some patients but evidence is limited.ConclusionsWhile the effectiveness of ONS compared to sham control has been shown in multiple RCTs, the average effect size is modest and may be exaggerated by bias as achieving effective blinding remains a methodological challenge. Further measures to reduce the risk of adverse events and revision surgery are needed.Systematic Review Registrationthis systematic review is an update and expanded work of part of a broader review registered with PROSPERO. Registration No. CRD42012002633.

KW - Migraine

KW - Headaches

KW - Case series

KW - Adverse events

KW - Randomized controlled trials

KW - Prisms

KW - Surgical and invasive medical procedures

KW - Systematic reviews

U2 - 10.1371/journal.pone.0116786

DO - 10.1371/journal.pone.0116786

M3 - Article

C2 - 25793740

VL - 10

JO - PLoSONE

JF - PLoSONE

SN - 1932-6203

IS - 3

M1 - e0116786

ER -