Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Combined Invasive Peripheral Nerve Stimulation in the Management of Chronic Post-Intracranial Disorder Headache. A Case Report.

Athanasia Alexoudi
* ,
Eustathios Vlahakis
ORCID logo ,
Stamatios Banos
,
Konstantinos Oikonomou
,
Panayiotis Patrikelis
,
Anastasia Verentzioti
,
Maria Stefanatou
,
Stylianos Gatzonis
,
Stefanos Korfias
,
Damianos Sakas
Version 1 : Received: 17 January 2023 / Approved: 23 January 2023 / Online: 23 January 2023 (00:57:59 CET)

A peer-reviewed article of this Preprint also exists.

Alexoudi, A.; Vlachakis, E.; Banos, S.; Oikonomou, K.; Patrikelis, P.; Verentzioti, A.; Stefanatou, M.; Gatzonis, S.; Korfias, S.; Sakas, D. Combined Invasive Peripheral Nerve Stimulation in the Management of Chronic Post-Intracranial Disorder Headache: A Case Report. Clin. Pract. 2023, 13, 297-304. Alexoudi, A.; Vlachakis, E.; Banos, S.; Oikonomou, K.; Patrikelis, P.; Verentzioti, A.; Stefanatou, M.; Gatzonis, S.; Korfias, S.; Sakas, D. Combined Invasive Peripheral Nerve Stimulation in the Management of Chronic Post-Intracranial Disorder Headache: A Case Report. Clin. Pract. 2023, 13, 297-304.

Abstract

The introduction of ventricular shunts dramatically changed the outcome and quality of life of hydrocephalic patients. However, shunt surgery continues to be associated with numerous adverse events. Headache is one of the most common complications after shunt operation. It is often over a prolonged duration, the symptoms resemble migraine, and pain does not respond to medication. We propose invasive peripheral nerve stimulation as a possible solution in the treatment of patients suffering from chronic headache associated with shunted hydrocephalus. A young woman with daily holocephalic headache with diffuse pain exacerbated by lying down. Imaging revealed panventricular enlargement and possible stenosis of the aqueduct. When a ventriculoperitoneal shunt was placed, clinical symptoms resolved. Nevertheless, she gradually exacerbated after a second valve replacement due to wound infection. Imaging revealed decompressed ventricles and appropriate shunt placement. The diagnosis of chronic post-intracranial disorder headache was set. Therefore, occipital nerve stimulation was applied and considering that the patient had not a total response, bilateral parietal stimulation was added. Three months after the combined PNS she experienced total remission of headache. Combined PNS eases refractory headaches much more than occipital nerve stimulation alone and could be considered as a solution for shunted hydrocephalus associated headache.

Keywords

Combined Peripheral Nerve Stimulation; occipital nerve stimulation; secondary headache disor-ders; chronic post-intracranial disorder headache and case report

Subject

Medicine and Pharmacology, Neuroscience and Neurology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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