Cluster headaches and gammaCore

This is a new guideline from NICE on the use of gammaCore for cluster headaches. It was published in Dec 19.

It should be used by specialists.

Why is a new treatment important?

About 5 people a year in the UK commit suicide because of cluster headaches. The side-effects from conventional medications and the monitoring required can be difficult.

What is gammaCore?

It is a non-invasive vagus nerve stimulator. The patient puts gel on the right point in their neck. The device, which is small and portable, is then held over the neck and it delivers a  small electric current for 2 mins. This is repeated 3 times. This can then be repeated multiple times in a 24 hr period.

It should be used multiple times during the day to prevent attacks and then can be used acutely during an attack to relieve pain.

The company provides training to patients on how to use it. This is free.

Is it suitable for everyone?

It can't be used on patients with active implantable medical devices, in those with cardiac disease, those who are pregnant and in children.

Does it work?

The studies are relatively small and have run for quite short periods of time. Most of them have also been financed by the gammaCore company. NICE advises that the evidence suggests that people with cluster headaches may benefit from using gammaCore either preventatively or acutely. However the degree of benefit is uncertain.

It doesn't work for everyone. About 25 to 50% of people with cluster headaches will respond to it, so it is advised to do a 3 months trial first. It should only be continued in those whose symptoms reduce within 3 months. It seems that for most who respond to gammaCore, they continue to do so.

There does seem to be a cost saving associated (as long as the first 3 months is provided for free) because of the reduced use of subcutaneous sumatriptan.

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