Occipital Nerve Stimulation For Hemiplegic Migraine Headaches
Alexander Yakovlev, MD; Angela M. Parmentier, APNP; Alexander Timchenko, MD; Jammi Cairnes, APNP
INTRODUCTION: Patient reports gradually worsening blurred vision and head pain, followed by numbness and tingling to the right arm and the right side of his face, weakness in his right arm and leg leading to nearly complete paralysis of his right side, with symptoms lasting up to four hours. He reports these headaches on average three times a week of varying degrees of intensity and right sided involvement. This 51 year old gentleman reported his first hemiplegic migraine in his forties. After trialing several abortive and preventative medications with various side effects, patient was referred to pain management.
METHODS: Initially trigger point injections to the occipital muscles and greater and lesser right sided occipital nerve blocks were somewhat successful at decreasing the frequency of headaches. After six months injections had minimal response and occipital nerve stimulation was offered to the patient. Two octad leads were placed over the right occipital region at the level of C1 and connected to a temporary unit and complex programming of occipital nerve stimulator leads was performed.
RESULTS: Patient underwent a four day headache-free trial, requesting to proceed with implantation. Patient proceeded with permanent implantation of SCS and reports use of stimulator several times a week. He has reported no sensory or motor right-sided symptoms since using his occipital stimulator.
CONCLUSIONS: Hemiplegic migraine headaches are rare, but one of the most serious and potentially debilitating migraine headaches. Research is limited on treating these headaches with medication such as, verapamil, acetazolamide, flunarizine, ketamine, lamotrigine, and naloxone. Occipital nerve stimulation may benefit patients with debilitating and intractable hemiplegic migraine headaches.
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