Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
Neuromodulation. 2012 Jul;15(4):381-6. doi: 10.1111/j.1525-1403.2012.00436.x. Epub 2012 Feb 29.
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.
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.
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.
Occipital nerve stimulation was effective in a patient with chronic, refractory hypnic headache.
催眠性头痛是一种罕见的原发性头痛疾病，仅在睡眠期间定期发生。我们报告了一例成功通过枕神经刺激治疗的催眠性头痛病例。
一名 64 岁女性出现了四年的右侧枕部头痛病史，该头痛会定期将她从睡眠中唤醒。头痛呈钝痛和搏动性，通常在晚上 11 点入睡后五个小时的凌晨 4 点准时发作。没有畏光、恶心、呕吐、流泪或其他自主神经症状。头痛对各种药物治疗（包括吲哚美辛、氟桂利嗪、普萘洛尔）均无反应。她接受了使用内侧入路的电极进行枕神经刺激的试验。
在十天的试验刺激期间，她报告说几乎完全缓解了催眠性头痛。慢性枕神经刺激复制了试验结果。一年后，随着刺激引起的感觉异常的丧失，催眠性头痛发作再次出现；随后的 X 光显示电极移位。将电极重新调整到原始位置后，枕神经刺激对催眠性头痛的有效性再次得到实现，并且在 36 个月的随访中一直保持有效。
枕神经刺激对慢性、难治性催眠性头痛患者有效。
