Neurologist Wim Mulleners has been appointed professor of Neurology, in particular head and facial pain, at Radboudumc / Radboud University. Mulleners works at the Canisius Wilhelmina Hospital (CWZ) in Nijmegen. From the STZ expertise center for head and facial pain, he focuses on the diagnosis and treatment of headaches in general and cluster headaches in particular. With this appointment, Radboud University Medical Center and CWZ are continuing their close collaboration in the field of these disorders.
Cluster headache is a rare form of headache that manifests itself in extremely severe attacks of pain. These attacks can recur daily for months, and sometimes even occur chronically. A condition with a major impact, says Wim Mulleners. ‘The attacks vary from fifteen minutes to three hours and can occur up to eight times a day. Also at night. The consequences for people with this condition are great. Consider sleep deprivation and absenteeism due to illness. Moreover, the pain is really terribly intense, people don’t know where to look during an attack.’
This pain is caused by activation of a cranial nerve and the associated area in the brain stem. It often manifests itself on one side of the face. There are treatment options, such as different types of medication. If this does not work, some patients are eligible for stimulation of certain nerves, occipital neurostimulation (ONS). During the ONS procedure, the doctor implants a small neurostimulator under the skin, at the back of the head near the occipital nerve. This intervention gives good results, according to Mulleners: ‘We have demonstrated the effectiveness of occipital neurostimulation in chronic cluster headaches. The number and severity of headache attacks decrease drastically. Some patients even become seizure-free. CWZ is one of three hospitals in the Netherlands that offer this procedure.’
Another form of neuromodulation is a blockade of the sphenopalatine ganglion. The pain specialist treats a nerve in the face, which is located next to the maxillary sinus behind the nose. This procedure is performed at the Radboud university medical center. The collaboration between Radboud University Medical Center and CWZ will be continued with this chair, says Mulleners. ‘We already work together regarding the interventions, but we will now also conduct more joint research. We want to better map the effectiveness and mechanism of action of occipital neurostimulation and sphenopalatine blockade for cluster headache. Why does this procedure work for many people? With more knowledge we can optimize these innovative treatments.’
Wim Mulleners’ chair also includes two other research fields. Once again in a collaboration between Radboudumc and CWZ, among others, he will conduct research into low doses of psychedelics as a medicine for chronic cluster headaches. He hopes to be able to start this in 2024. Finally, his research focuses on better accessibility of care for headache patients. ‘We must focus on the patient’s individual needs. This requires agreements and cooperation with general practitioners and other healthcare providers. We also have to look at digitalization. We want to roll out our ideas regionally and test them for effectiveness, quality and efficiency. Because care for patients with headaches can and must be improved.’
Wim Mulleners studied Medicine in Utrecht and obtained his PhD for research into migraine and an overstimulated brain (title thesis: Exciting excitable brains – a transcranial magnetic stimulation study in migraine). He trained as a neurologist at CWZ, after which he worked as a medical specialist in Heerlen for several years. He has been working at CWZ since 2003 and is the head of the STZ Expertise Center for Head and Facial Pain. He is also chairman of the Dutch Headache Association. His appointment as professor by special appointment of Neurology, in particular head and facial pain, took effect on October 1, 2023 and is valid for a period of three years.