title: Concordant occipital and supraorbital neurostimulation therapy for hemiplegic migraine; initial experience; a case series.
abstract: BACKGROUND
  Hemiplegic migraine is a particularly severe form of the disease that often evolves to a debilitating chronic illness that is resistant to commonly available therapies. Peripheral neurostimulation has been found to be a beneficial therapy for some patients among several diagnostic classes of migraine, but its potential has not been specifically evaluated for hemiplegic migraine.
  
  
  METHODS
  Four patients with hemiplegic migraine were treated with concordant, combined occipital and supraorbital neurostimulation over periods ranging 6-92 months. The clinical indicators followed included assessments of headache frequency and severity, frequency of hemiplegic episodes, functional impairment, medication usage, and patient satisfaction.
  
  
  RESULTS
  All reported a positive therapeutic response, as their average headache frequency decreased by 92% (30 to 2.5 headache days/month); Visual Analog Score by 44% (9.5 to 5.3); frequency of hemiplegic episodes by 96% (7.5 to 0.25 hemiplegic episodes/month); headache medication usage by 96% (6 to 0.25 daily medications); and Migraine Disability Assessment score by 98% (249 to 6). All were satisfied and would recommend the therapy, and all preferred combined occipital-supraorbital neurostimulation to occipital neurostimulation alone.
  
  
  CONCLUSIONS
  Concordant combined occipital and supraorbital neurostimulation may provide effective therapy for both the pain and motor aura in some patients with hemiplegic migraine.
authors: Interventional Pain Management and Internal Medicine, Reed Migraine Centers, Dallas, TX, USA.
authors: Ken L
authors: http://orcid.org/0000-0002-3327-8143
authors: KL
authors: Reed
authors: Interventional Pain Management, Texas Institute of Surgery, Dallas, TX, USA.
authors: Kelly R
authors: KR
authors: Will
authors: Department of Neurology, Florida State University College of Medicine, West Palm Beach, FL, USA.
authors: Frank
authors: F
authors: Conidi
authors: Interventional Pain Management, Department of Anesthesiology, Presbyterian Hospital of Dallas, Dallas, TX, USA.
authors: Robert
authors: R
authors: Bulger
mesh_terms: D000328:Adult; D003391:Cranial Nerves / Q000502:physiology*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000628:therapy*; D009915:Orbit / Q000294:innervation; D010147:Pain Measurement; D012189:Retrospective Studies; D013127:Spinal Nerves / Q000502:physiology*; D016896:Treatment Outcome
keywords: Chronic migraine; combined occipital and supraorbital nerve stimulation; hemiplegic migraine; migraine; occipital nerve stimulation