• Byung-Chul Son, Seung-Ho Yang, Jae-Taek Hong, and Sang-Won Lee.
• Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea. sbc@catholic.ac.kr
• Neuromodulation. 2012 Jul 1;15(4):381-6.

ObjectiveHypnic 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.Materials And MethodsA 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.ResultsDuring 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.ConclusionOccipital nerve stimulation was effective in a patient with chronic, refractory hypnic headache.© 2012 International Neuromodulation Society.

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