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.

Keywords: indomethacin sensitive headache; intractable headache; neurostimulation; occipital nerve stimulation; paroxysmal hemicrania; pregnancy; trigeminal autonomic cephalalgia.