title: Neuromodulation as a last resort option in the treatment of chronic daily headaches in patients with idiopathic intracranial hypertension.
abstract: OBJECTIVE
  To determine the feasibility and efficacy of occipital nerve stimulation (ONS) in patients with refractory headaches secondary to idiopathic intracranial hypertension (IIH).
  
  
  BACKGROUND
  IIH is a syndrome characterized by elevated intracranial pressures in the absence of a mass lesion. These patients typically present with chronic and intractable headaches. Cerebrospinal fluid (CSF) diversion fails in relieving the headache in a significant proportion of this population. ONS has been shown to be effective in medically refractory headaches and to our knowledge, has not been attempted as a therapeutic modality in this population.
  
  
  METHODS
  Four patients with occipital predominant chronic daily headaches and IIH who failed medical management underwent bilateral ONSs. Octopolar percutaneous electrodes were implanted in the defined area of pain. Visual Analog Scale (VAS) was used as an outcome measure. Patient demographics and surgical complications were also reviewed in this retrospective study. Following the trial period, all patients had >50% pain reduction resulting in permanent implantation.
  
  
  RESULTS
  All 4 patients had an average improvement of their VAS scores by 75%, with 85% spatial coverage and the remainder of the uncovered region being frontal. Sustained benefits were seen up to 3 years of follow-up. One patient had a lead erosion requiring removal followed by delayed re-implantation and another lost treatment efficacy at 2 years resulting in explantation. One patient required CSF diversion due to visual threat during the follow-up period but maintained sustained benefit from her ONS.
  
  
  CONCLUSIONS
  Bilateral ONS may be a useful treatment option in the management of selected patients with IIH, after standard surgical interventions have been attempted. Bilateral ONS may provide therapeutic option for management of residual headaches in these complicated patients.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Shaw
authors.forename: Mayur
authors.initials: M
authors.lastname: Sharma
authors.forename: Ammar
authors.initials: A
authors.lastname: Shaikhouni
authors.forename: Evan S
authors.initials: ES
authors.lastname: Marlin
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ikeda
authors.forename: John M
authors.initials: JM
authors.lastname: McGregor
authors.affiliation: Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Milind
authors.initials: M
authors.lastname: Deogaonkar