Occipital Nerve Stimulation for Medically Refractory Chronic Paroxysmal Hemicrania
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Published on: September 13, 2024
Sarah Miller1, Susie Lagrata1, Laurence Watkins2
1Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
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.
