Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 4 specialists were familiar with or had used this technology before.

Level of innovation

All 4 specialists agreed that gammaCore was innovative. The specialists stated that gammaCore is different to other treatments for cluster headache. The specialists noted that gammaCore has no known side effects and needs no clinical monitoring, unlike the medications used to treat cluster headache. The specialists noted that gammaCore is the only nerve stimulator for cluster headache that does not need to be surgically implanted.

Potential patient impact

Three specialists stated that gammaCore is likely to be beneficial to people with cluster headache because it has no known side effects and can be used as many times a day as needed. This means that there is potential for gammaCore to be a treatment option for people with cluster headache for whom current treatments are not effective or tolerable. One specialist noted that gammaCore had the potential to reduce the amount of medication needed to treat cluster headache. Two specialists noted that gammaCore was effective in about 50% of people with cluster headache based on their clinical practice. The specialists stated that use of gammaCore has led to life changing improvements for some people, allowing them to return to work and normal activities. The specialists noted that there is a high risk of suicide for people with cluster headache and that many of these patients have significant unmet needs.

The specialists stated that gammaCore was easy to teach and use and people with cluster headache had good compliance with the treatment when using it at home every day. One specialist noted that although gammaCore needs conductive gel to be used many people find this mode of administration preferable to self-injecting or oxygen therapy. One specialist noted that gammaCore was portable and easy to use on the go.

The specialists agreed that gammaCore could be used by anyone with cluster headache but would be particularly beneficial for those people in whom current treatments are not tolerated or are contraindicated. For example, people for whom triptans, high-flow oxygen and verapamil are ineffective or people with cardiovascular disease.

Potential system impact

All 4 specialists agreed that gammaCore had the potential to save money through the NHS by reducing the cost of treating cluster headache. The specialists noted that people with cluster headache for whom gammaCore is successful are likely to have fewer future complications and disabilities because of their condition. This is likely to reduce the need for expensive drug and oxygen therapy (and monitoring thereof), A&E visits, hospital admissions and a reduced need for invasive surgical procedures. Two specialists noted that if people with cluster headache are able to use gammaCore at home to control their symptoms then the workload on headache specialists in the NHS will decrease. One specialist stated that there could be an increase in the workload of headache specialists if the introduction of gammaCore encourages more people to seek treatment.

General comments

Specialist commentators advise that cluster headache affects 1:1,000 population and around 5% of these people will not have enough symptom control with standard care. The specialists noted that once trained to use gammaCore, most people will not need any further assistance. However, it should be noted that a moderate level of dexterity is needed to use the device. The specialist commentators noted that the evidence for gammaCore showed positive outcomes in line with their clinical experience and was of high quality, particularly in comparison to the quality of research done in cluster headache in general. However, all specialists noted that further real world data would help to address questions on how long the treatment is effective for, how to best select patients and the economic effect on the NHS.