Occipital Nerve Stimulation for Medically Refractory Chronic Paroxysmal Hemicrania.

Abstract

OBJECTIVE:

To describe the outcome of a patient with refractory chronic paroxysmal hemicrania (CPH) to occipital nerve stimulation (ONS).

BACKGROUND:

CPH is a primary headache disorder exquisitely sensitive to indomethacin. In patients unable to tolerate indomethacin, the therapeutic options are limited. ONS is a promising therapy for other refractory headache conditions. We report the first patient with medically refractory CPH treated with ONS.

METHODS:

Following implantation of the occipital nerve stimulator in 2006, the patient kept prospective headache diaries. Outcome was assessed by daily attack frequency.

RESULTS:

After a follow-up of over 10 years, the patient reported a sustained efficacy of more than 50% reduction in attack frequency and was pain-free at final follow-up. The patient was able to stop indomethacin completely. The patient had three successful pregnancies during follow-up. One system revision was undertaken alongside an expected battery replacement to treat unequal paresthesia and pain over the electrodes.

CONCLUSION:

ONS may offer an effective long-term treatment for CPH in patients where indomethacin cannot be tolerated.

• Authors: Sarah Miller, Susie Lagrata, Laurence Watkins, Manjit Matharu
• Journal: Headache (Headache) Vol. 57 Issue 10 Pg. 1610-1613 (Nov 2017) ISSN: 1526-4610 [Electronic] United States
• PMID: 28980700 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2017 American Headache Society.

Topics

• Adult
• Electric Stimulation Therapy
• Female
• Follow-Up Studies
• Humans
• Implantable Neurostimulators
• Paroxysmal Hemicrania (therapy)
• Spinal Nerves