Combined occipital and supraorbital nerve stimulation for treatment of ptosis associated with chronic cluster headache

Abstract

Cluster headache (CH) is a neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye that shares a component of parasympathetic autonomic symptoms. We report a 40-year-old female who presented with migraine headaches, occipital pain and experienced daily headaches behind the right eye. It was associated with lacrimation of her right eye, erythema, and ptosis, in which her eye would partially to fully close. After failure of multiple conservative measures, she was treated with a combination of bilateral occipital nerve and right supraorbital stimulation. The patient obtained significant relief from neurostimulation. She returned to work and initially was able to stop all medications. On 1-year follow-up, the patient is on preventive medication which includes Depakote. The patient continues with significant relief and has had no return of her autonomic features, including ptosis. Neurostimulation is a viable option in the treatment of CHs, including those with disabling autonomic features. The use of combined occipital nerve and supraorbital stimulation administers relief for both headache component and autonomic symptoms. The following core competencies are addressed in this article: Medical knowledge and patient care. The article addresses the lack of awareness surrounding neuromodulation, as well as expanding indications for an established therapy.