Extended Long‐Term Effects of Cervical Vagal Nerve Stimulation on Headache Intensity/Frequency and Affective/Cognitive Headache Perception in Drug Resistant Complex‐Partial Seizure Patients

Objectives Invasive vagal nerve stimulation (iVNS) is an established treatment option for drug‐resistant focal seizures and has been assumed to diminish frequent co‐incidental daily headache/migraine. However, long‐term effects on cognitive/affective head pain perception, headache intensity/frequency are lacking. We therefore investigated potential iVNS‐induced effects in patients with drug‐resistant focal seizure and daily headache/migraine. Materials and Methods A clinical database was used to select 325 patients with drug‐resistant epilepsy treated by either iVNS plus best medical treatment (BMT) or BMT alone, compared to a healthy control group (HC). We assessed headache intensity (VAS), headache frequency, affective/cognitive pain perception (PASS; FSVA), migraine disability scores (MIDAS), sleep architecture (PSQI), depressive symptoms (BDI), and body weight (BMI). Results Nineteen patients with daily headache/migraine composed the clinical groups (10 iVNS and 9 BMT; iVNS mean age 49 years, range 36–61 years; BMT mean age 45 years, range 23–63 years; equally distributed gender). Cervical iVNS was applied from 5–13 years (mean 8 years) with following stimulation patterns: 1.3 mA (0.5–2 mA), 20 Hz, 250 μsec, 30 sec on/1.9 min off (0.5–5 min). The iVNS group had significantly lower VAS scores (iVNS 5.4; BMT 7.8; p = 0.03) and PASS cognitive/anxiety subscores (iVNS 21; BMT 16; p = 0.02) compared to BMT and HC. Global PASS (p = 0.07), FSVA, PSQI, BDI, and BMI scores did not differ significantly between groups. Conclusions iVNS appears to have positive modulatory long‐term effects on headache and affective/cognitive head pain perception in patients with drug‐resistant focal epilepsy, thus deserving further attention.