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Treatment of intractable hemicrania continua by occipital nerve stimulation
  1. Sarah Miller1,
  2. Laurence Watkins2,
  3. Manjit S Matharu1
  1. 1 Headache Group, Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
  2. 2 Department of Neurosurgery, Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
  1. Correspondence to Dr Manjit S Matharu, Headache Group, Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; m.matharu{at}uclmail.net

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Introduction

Hemicrania continua (HC) is characterised by a strictly unilateral continuous headache with ipsilateral autonomic features and migrainous symptoms that is exquisitely sensitive to indomethacin.1 As more than 30% of patients report side effects with indomethacin, there is need for an effective and safe alternative. Although several drugs have been used in open-label studies, none offer the same magnitude of response.

Occipital nerve stimulation (ONS) has been performed in headache conditions such as chronic migraine and chronic cluster headache, both conditions with clinical similarities to HC and appears to be a safe, potentially efficacious treatment even in those failing all available medical treatments.2 We report the long-term follow-up of a new cohort of 16 patients with HC treated with ONS.

Patients and methods

Sixteen patients with a diagnosis of HC were implanted with bilateral ONS by a single specialist team between 2008 and 2013. Patients were diagnosed in accordance with the International Classification of Headache Disorders criteria.3 All had unilateral headaches fully responsive to an oral or intramuscular Indotest,4 but had suffered intolerable side effects or had contraindications to long-term use of the drug. Patients had failed to respond to trials of at least five other medications with limited evidence of efficacy in HC: cyclo-oxygenase inhibitors, topiramate, verapamil, gabapentin, pregabalin, melatonin and flunarizine.

Procedures were offered under the supervision of local clinical effectiveness supervisory committee and ethical board approval for collection and …

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