A New Treatment Option for Children With Refractory Chronic Paroxysmal Hemicranias: Occipital Nerve Stimulation

Abstract

Chronic paroxysmal hemicrania (CPH) is a rare primary headache disorder in pediatric population: 32 cases are described. 1 Evers S. Summ O. Frese A. Very young age of onset in trigemino-autonomic cephalalgias - case report and review of the literature. Cephalalgia. 2020; 40: 1385-1388 Crossref Scopus (3) Google Scholar , 2 Mauritz M.D. Enninger A. Wamsler C. Wager J. Zernikow B. Long-term outcome of indomethacin treatment in pediatric patients with paroxysmal hemicrania-a case series. Children (Basel). 2021; 8: 101 Google Scholar , 3 Ishii R. Fukazawa R. Takezawa H. Fujii A. Case report: shortest course of pediatric paroxysmal hemicrania. Headache. 2019; 59: 1084-1087 Crossref Scopus (4) Google Scholar It responds to indomethacin, but one-third of patients have dose-limiting side effects and one-fifth have to discontinue owing to drug intolerability. More than two-third of patients suffer from a chronic form. Occipital nerve stimulation (ONS) could be considered as alternative in medically refractory chronic primary headache. 4 Martelletti P. Jensen R.H. Antal A. et al. Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain. 2013; 14: 86 Crossref PubMed Scopus (140) Google Scholar ,5 Lambru G. Matharu M.S. Occipital nerve stimulation in primary headache syndromes. Ther Adv Neurol Disord. 2012; 5: 57-67 Crossref PubMed Scopus (28) Google Scholar The first adult case has been published in 2017. 6 Miller S. Lagrata S. Watkins L. Matharu M. Occipital nerve stimulation for medically refractory chronic paroxysmal hemicrania. Headache. 2017; 57: 1610-1613 Crossref Scopus (9) Google Scholar We describe the first pediatric patient with CPH to undergo ONS.