Nerve stimulation for indomethacin-intolerant hemicrania continua.
- 1College of Medicine, Drexel University, Philadelphia, United States.
- 2Department of Neuroscience, Allegheny Health Network Neuroscience Institute, Pittsburgh, Pennsylvania, United States.
Abstract
Background
Hemicrania continua is a headache disorder characterized by a unilateral headache that lasts for at least 3 months. Current management for hemicrania continua is centered around using indomethacin. However, in cases of hypersensitivities and adverse reactions to indomethacin require using alternative treatment.Case description
We describe a 62-year-old woman with a history of meningitis who developed persistent left-sided headaches and was diagnosed with hemicrania continua. Her symptoms included continuous occipital and retro-orbital pain and ipsilateral cranial autonomic features. Indomethacin was initially effective but discontinued due to gastrointestinal bleeding. Multiple pharmacologic therapies and interventional strategies, including nerve blocks and botulinum toxin, failed to provide lasting relief. Persistent upper cervical pain radiating to the left skull and left supraorbital region prompted a trial of left occipital nerve stimulation. Following a successful trial, an occipital nerve stimulator was implanted, resulting in immediate symptom relief. At 1-year follow-up, the patient reported a 70% reduction in pain, improvement in quality of life, and discontinued opioid and topiramate medications. However, ongoing retro-orbital pain prompted a subsequent trial of left supraorbital nerve stimulation, resulting in an additional 70% reduction in retro-orbital pain. Combined occipital and supraorbital stimulation resulted in a sustained >70% overall pain reduction, which remained stable at 5-month follow-up.Conclusion
Occipital and supraorbital nerve stimulation may offer effective relief in hemicrania continua patients who are intolerant of indomethacin. Additional studies are needed to better understand indications for stimulator use in headache disorders, optimal lead placement for effective stimulation, and to investigate cases in which unilateral primary headaches evolve to involve the contralateral side.
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BibTeX
@article{iovenko2026nerve,
title = {{Nerve stimulation for indomethacin-intolerant hemicrania continua.}},
author = {Dmytro Iovenko and Stephen Jaffee and Nestor Tomycz and Michael Patterson},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_640_2026},
url = {https://europepmc.org/article/MED/42974529},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Nerve stimulation for indomethacin-intolerant hemicrania continua.
AU - Dmytro Iovenko
AU - Stephen Jaffee
AU - Nestor Tomycz
AU - Michael Patterson
PY - 2026
DA - 2026/10/02
JO - Surgical neurology international
DO - 10.25259/sni_640_2026
UR - https://europepmc.org/article/MED/42974529
AB - Background Hemicrania continua is a headache disorder characterized by a unilateral headache that lasts for at least 3 months. Current management for hemicrania continua is centered around using indomethacin. However, in cases of hypersensitivities and adverse reactions to indomethacin require using alternative treatment.Case description We describe a 62-year-old woman with a history of meningitis who developed persistent left-sided headaches and was diagnosed with hemicrania continua. Her symptoms included continuous occipital and retro-orbital pain and ipsilateral cranial autonomic features. Indomethacin was initially effective but discontinued due to gastrointestinal bleeding. Multiple pharmacologic therapies and interventional strategies, including nerve blocks and botulinum toxin, failed to provide lasting relief. Persistent upper cervical pain radiating to the left skull and left supraorbital region prompted a trial of left occipital nerve stimulation. Following a successful trial, an occipital nerve stimulator was implanted, resulting in immediate symptom relief. At 1-year follow-up, the patient reported a 70% reduction in pain, improvement in quality of life, and discontinued opioid and topiramate medications. However, ongoing retro-orbital pain prompted a subsequent trial of left supraorbital nerve stimulation, resulting in an additional 70% reduction in retro-orbital pain. Combined occipital and supraorbital stimulation resulted in a sustained >70% overall pain reduction, which remained stable at 5-month follow-up.Conclusion Occipital and supraorbital nerve stimulation may offer effective relief in hemicrania continua patients who are intolerant of indomethacin. Additional studies are needed to better understand indications for stimulator use in headache disorders, optimal lead placement for effective stimulation, and to investigate cases in which unilateral primary headaches evolve to involve the contralateral side.
SN - 2229-5097
SN - 2152-7806
ER -