Occipital Nerve Stimulation for Medically Refractory Chronic Paroxysmal Hemicrania



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


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.


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


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.


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


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