EPV182 - COMPINED BILATERAL OCCIPITAL AND SUPRAORBITAL STIMULATION IN MANAGEMENT OF DRUG – RESISTANT HYDROCEPHALUS RELATED HEADACHE. (ID 261)
- Efstathios Vlachakis, Greece
- Stefanos I. Korfias, Greece
- Athanasia Alexoudi, Greece
- Efstathios Vlachakis, Greece
- Argyro G. Chondrozoumaki, Greece
- Stamatis Banos, Greece
- Alexandros Tsimogiannis, Greece
- Alexandros Kossivas, Greece
- Dimitrios Skarmoutsos, Greece
- Christina Zournatzidou, Greece
- Panayiotis Patrikelis, Greece
- Stergios Gatzonis, Greece
- Damianos E. Sakas, Greece
Abstract
Introduction
We present a successful treatment of a patient with a chronic migraine treated with combined subcutaneous Occipital Nerve Stimulation (ONS) and Supraorbital Nerve Stimulation (SNS).
Methods/Materials
A 33-year-old woman presented with a drug-resistant diffuse daily headache associated with gait impairment and visual symptoms. Brain MRI revealed ventricular enlargement and possible aqueduct stenosis. Intracranial Pressure (ICP) telemetry proved high ICP values (>30mmHg). A ventriculo-peritoneal (VP) shunt was placed and post-operatively the ICP gradually measured within the normal range (<15mmHg). However, patient’s symptoms did not resolve and a brain CT scan revealed no intracranial pathology, stably decompressed ventricles, and appropriate VP shunt placement.
Results
The diagnosis of chronic post-intracranial disorder headache was set. Subsequently, a subcutaneous ONS was performed and considering that patient had not a total response an additional SNS was applied. Three months after the bilateral combined ONS–SNS the headache promptly and completely resolved, the quality of life was improved and she remained completely free off medications.
Discussion
Patient with ventricular enlargement and possible aqueduct stenosis presented with a diffuse headache that was initially treated unsuccessfully with a VP shunt insertion. This headache had the characteristics of chronic migraine mediated through the trigeminovascular system. Combined ONS–SNS proved successful in dealing with this situation.
Conclusions
Our report confirms the historical data that combined ONS–SNS ease refractory headaches much more than ONS does alone.
