Abstract text (incl. figure legends and references)

Introduction

GammaCore is a non-invasive vagus nerve stimulator (nVNS) which modifies pain pathways and has been approved by NICE for management of cluster headaches. For use in other headache disorders, in the UK, an IGFR form needs to be completed.

Cluster headache (CH) is a trigeminal autonomic cephalalgia characterised by severe, strictly unilateral headache attacks accompanied by ipsilateral autonomic symptoms and restlessness associated with suicide.

Objective

To assess the effectiveness of gammaCore in management of headache disorders

Methods

Retrospective review of 100 patients who are currently using gammaCore was undertaken

Results

Out of 100 patients (F:M 62:38), with an average age of 48, 52 had CH, 39 hemicrania continua (HCC), 3 SUNCT, 4 NDPH and 2 CM.

On Average 6 previous preventatives were tried including Verapamil, Botox and CGRP MABs. Duration of treatment was 1.5 years on average, with one patient on treatment for over 6 years.

Headache diaries was available in 57 patients at start of treatment and 36 at 3 months, 20 at 6 months and 16 at 1 year. At 3 months, there was 6 days reduction in severe days and 7 day increase in clear days for the entire group. Patients with CH continued to show 8 days reduction in severe days at 1 year. Please see attached table.

Conclusion

In our experience, GammaCore is effective in management of a variety of headache disorders, particularly CH.

The flaws in our study are limited headache diary data, due to a number of factors including lack of compliance and storage of the information, and lack of data on tolerability.