Concordant Occipital and Supraorbital Neurostimulation Therapy for Hemiplegic Migraine; Initial Experience; A Case Series

• Published in: Neuromodulation (Malden, Mass.) Vol. 18; no. 4; pp. 297 - 304
• Main Authors: Reed, Ken L., Will, Kelly R., Conidi, Frank, Bulger, Robert
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2015; Elsevier Limited; John Wiley and Sons Inc
• Subjects: Adult; Case Series; Chronic migraine; combined occipital and supraorbital nerve stimulation; Cranial Nerves - physiology; Electric Stimulation Therapy - methods; Female; Headaches; hemiplegic migraine; Humans; Longitudinal Studies; Male; Middle Aged; Migraine; Migraine with Aura - therapy; Mutation; occipital nerve stimulation; Orbit - innervation; Pain Measurement; Patient satisfaction; Peripheral Nerve Stimulation; Retrospective Studies; Spinal Nerves - physiology; Treatment Outcome; Chronic migraine; hemiplegic migraine; occipital nerve stimulation; migraine; combined occipital and supraorbital nerve stimulation
• ISSN: 1094-7159; 1525-1403
• DOI: 10.1111/ner.12267

Introduction Hemiplegic migraine is a particularly severe form of the disease that often evolves to a debilitating chronic illness that is resistant to commonly available therapies. Peripheral neurostimulation has been found to be a beneficial therapy for some patients among several diagnostic classes of migraine, but its potential has not been specifically evaluated for hemiplegic migraine. Materials and Methods Four patients with hemiplegic migraine were treated with concordant, combined occipital and supraorbital neurostimulation over periods ranging 6–92 months. The clinical indicators followed included assessments of headache frequency and severity, frequency of hemiplegic episodes, functional impairment, medication usage, and patient satisfaction. Results All reported a positive therapeutic response, as their average headache frequency decreased by 92% (30 to 2.5 headache days/month); Visual Analog Score by 44% (9.5 to 5.3); frequency of hemiplegic episodes by 96% (7.5 to 0.25 hemiplegic episodes/month); headache medication usage by 96% (6 to 0.25 daily medications); and Migraine Disability Assessment score by 98% (249 to 6). All were satisfied and would recommend the therapy, and all preferred combined occipital–supraorbital neurostimulation to occipital neurostimulation alone. Conclusions Concordant combined occipital and supraorbital neurostimulation may provide effective therapy for both the pain and motor aura in some patients with hemiplegic migraine.