Cluster headache is a highly debilitating primary headache disorder which is widely described as the most painful condition a human can experience, with cluster headache having a major negative impact on personal life, self-perceived health, and societal costs. It is a life-long condition with treatment taking on two main forms: abortive and preventative.

The main acute treatment is triptans (nasal spray or injection), but they are expensive, not always effective, and can only be used a limited number of times per day. Breathing high-flow oxygen during an attack can help some patients but not all and is not safe for smokers. Preventive treatments such as verapamil,  topiramate, lithium, prednisolone, can all have quite marked side effects and each of these is only effective in a subset of patients. Treatment will therefore take a trial-and- error approach and some patients will not find an effective treatment.

gammaCore is a non invasive vagus nerve stimulator which offers a non-pharmacological option for the treatment and prevention of cluster headaches. It is a handheld device designed to be self-administered by the patient or their carer.

What are the service user benefits?

  • Expected response rate to gammaCore is reported as being between 25% to 50%.

  • Reduction in the frequency of cluster headache attacks

  • Reduction of the intensity of pain during a cluster headache attack

  • Reduction in the use and reliance of pharmacological treatment options such as triptans (nasal or injection)

  • Improved quality of life and increased ability to participate in activities of normal daily life e.g. school, work, holidays.

How is this being implemented in Dorset?

NICE recommends (MTG46) the use of gammaCore to treat cluster headaches in the NHS with gammaCore a supported product within NHS England’s current Med Tech Funding Mandate policy. gammaCore has been a treatment option available from the Dorset Headache Service (based at University Hospitals Dorset) since late 2021. A copy of the case study summarising the implementation journey, as well as findings from a recent local evaluation, is available here.