4.6 Cross-Cutting Summary Table

Therapy	Best efficacy evidence	Responder definition used	Key safety issue	Availability 2025–2026	Australia
nVNS (gammaCore)	eCH acute: ACT2 48% vs 6% attacks pain-free at 15 min, p<0.01. cCH acute: no effect (ACT2 5% vs 13%). cCH preventive: PREVA 40% vs 8.3% ≥50% responders	Varies: pain-free at 15 min; ≥50% attack reduction	Benign. Perioral myokymia ~7%; no serious device-related AEs	Available, electroCore commercially healthy	Yes — ARTG 355575, Medistar. Prescription/authorisation only. NO subsidy. Price unpublished
SPG stimulation (Pulsante)	CH-1: 67.1% vs 7.4% pain relief at 15 min. CH-2: 62.5% vs 38.9%, OR 2.62, p=0.008. Registry: 65% therapeutic responders	Acute responder; ≥50% frequency reduction; “therapeutic responder” (either)	81% facial sensory disturbance (mostly transient, some permanent); 5 SAEs in CH-1	NOT AVAILABLE anywhere. Realeve holds FDA Breakthrough designation only; >700 patients stranded since 2019	No pathway
ONS	Open-label 53–69% responders; L-ICON 59% at ≥50% for ≥half of 4.2 yrs. But ICON found 30% dose = 100% dose, and Fogh-Andersen 2026 found placebo > burst ONS (p=0.042)	≥50% (ICON/L-ICON); ≥30% (Fogh-Andersen)	72% ≥1 SAE over 4.2 yrs; 50% needed further surgery; no biological SAEs. Modern technique far better (0 lead migrations in 45 pts)	Available — the only CE-marked invasive CH option	Performed in Australia at some centres for refractory cases; no specific data retrieved
DBS posterior hypothalamus	74.3% responders (78/105); frequency −70.1%; intensity −50.6%. Only RCT was negative	≥50% improvement in frequency and/or intensity	1 death (<1%); major complications 16.67%; haemorrhage 0.93–3%; irreversible dysarthria and diplopia reported; transient diplopia 22%	~108 published cases in 22 yrs; handful of tertiary centres; EAN makes no recommendation	No realistic pathway
Trigeminal section/rhizotomy	76% long-term full/near-complete relief (17 pts)	Informal	1 death, CSF leaks, meningitis, 2 patients needed surgery for corneal anaesthesia to prevent blindness; anaesthesia dolorosa	Historical	Not offered
Gamma knife	77% initial response; 42% persisting	“Meaningful pain reduction” (undefined)	58% trigeminal sensory disturbance; 6% deafferentation pain; irreversible	Essentially abandoned	Not offered
MVD	73.3% initial ≥50% relief; 46.6% long-term; 87.5% of redo operations failed	≥50% relief	“Minimal” morbidity per authors; posterior fossa craniotomy	Historical for CH; retained for TN and possibly SUNCT/SUNA	Rarely
GON blockade	4/14 good, 5/14 moderate, 5/14 none	Informal	Minimal, reversible	Widely used; counts towards EHF refractoriness criteria	Yes, routinely