gms | German Medical Science

Objective: Occipital nerve stimulation (ONS) has shown encouraging results in clinical trials of patients with intractable chronic migraine. So far, there has been no report on ONS in basilar type migraine. We treated a 29-years old female patient with a history of 12 years of combined chronic migraine (CM) and basilar type migraine according to the ICHD-II criteria.

Method: Surgery: 2 eight-pole cylindrical leads were implanted s.c. under local anesthesia. Intraoperative testing was performed to verify electrode positioning. An implantable pulse generator (Genesis 8TM; SJM) was placed s.c. in the lower abdomen. Stimulation parameters were chosen as follows: Pulse amplitude: left: 2,1 mA (0,9–3,3); right: 2,4 mA (1,2–3,6), pulse rate: 50 Hz, pulse width: 130 µs, continuous mode. Efficacy measures: efficacy of ONS was evaluated by evaluation of a standardized headache diary of a period of 4 months before and 7 months after surgery. Pain presence, intensity, duration, location, characteristics, accessory symptoms and acute and prophylactic pharmacologic treatment were assessed.

Results: Whereas CM frequency did not change significantly, the mean monthly frequency of basilar type migraine dropped from 3.5 (before surgery) to 1.7 (using ONS). The course of basilar type migraine was milder: before ONS, 40% of attacks presented with loss of consciousness leading to repeated cranial traumas; using ONS, the maximum degree of altered consciousness was somnolence, which only occurred in 15% of all episodes. Over all, headache duration diminished: before surgery, 99% of migraine attacks lasted for more than 12 h, whereas during ONS, episodes were shortened (<6 h in 42%, <12 h in 45%). As medication was reduced during the observational period, relevant pharmacological influence of the observed clinical improvement under ONS could be excluded.

Conclusions: To our knowledge, this is the first case report of ONS in a patient with combined CM and basilar type migraine. Confirmation of these observations in larger trials can not be expected due to low prevalence of basilar type migraine. While results of ONS trials in CM are discussed critically by headache specialist, the low invasiveness of the procedure justifies implantation in otherwise intractable cases of this rare entity.