title: Occipital nerve stimulation for medically refractory hypnic headache.
abstract: OBJECTIVE
  Hypnic headache is a rare, primary headache disorder that exclusively occurs regularly during sleep. We present a case of hypnic headache successfully managed with occipital nerve stimulation.
  
  
  METHODS
  A 64-year-old female presented with a four-year history of a right occipital headache that regularly awakened her from sleep. The headache, which was dull and throbbing, would awaken her regularly at 4:00 am, five hours after bedtime at 11:00 pm. No photophobia, nausea or vomiting, lacrimation, or other autonomic symptoms were present. The headache was refractory to various medical treatments, including indomethacin, flunarizine, propranolol. She underwent a trial of occipital nerve stimulation with a lead electrode using a medial approach.
  
  
  RESULTS
  During the ten-day trial stimulation, she reported almost complete relief from hypnic headache. Chronic occipital nerve stimulation replicated the trial results. The attacks of hypnic headache recurred in one year with loss of stimulation-induced paresthesia; a subsequent x-ray showed electrode migration. After revision of the electrode to the original location, the effectiveness of the occipital nerve stimulation against hypnic headache was achieved again, and this effect has been consistent through 36 months of follow-up.
  
  
  CONCLUSIONS
  Occipital nerve stimulation was effective in a patient with chronic, refractory hypnic headache.
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea. sbc@catholic.ac.kr
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Son
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Yang
authors.forename: Jae-Taek
authors.initials: JT
authors.lastname: Hong
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Lee
mesh_terms: D002908:Chronic Disease; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D051270:Headache Disorders, Primary / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology; D019919:Prosthesis Implantation; D011859:Radiography; D013127:Spinal Nerves / Q000502:physiology*