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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 …
Contributors SM: recruitment of subjects, analysis and interpretation of data, drafting and revision of manuscript; LW: performed surgery and manuscript revision; MSM: study concept, recruitment of subjects, interpretation of data and manuscript revision.
Competing interests SM has received educational and travel grants from St Jude Medical and Medtronic; LW has served on advisory boards for St Jude Medical and Medtronic; MSM serves on the advisory board for Allergan, St Jude Medical and Medtronic and has received payment for the development of educational presentations from Allergan, St Jude Medical, Medtronic and electroCore.
Provenance and peer review Not commissioned; externally peer reviewed.
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