ABSTRACT
A novel approach to the treatment of chronic migraine headaches based on neurostimulation of both occipital and supraorbital nerves was developed and reduced to clinical practice in a series of patients with headaches unresponsive to currently available therapies. Following positive trials, seven patients with chronic migraine and refractory chronic migraine headaches had permanent combined occipital nerve-supraorbital nerve neurostimulation systems implanted. The relative responses to two stimulation programs were evaluated: one that stimulated only the occipital leads and one that stimulated both the occipital and supraorbital leads together. With follow-up ranging from 1 to 35 months all patients reported a full therapeutic response but only to combined supraorbital-occipital neurostimulation. Occipital nerve stimulation alone provided a markedly inferior and inadequate response. Combined occipital nerve-supraorbital nerve neurostimulation systems may provide effective treatment for patients with chronic migraine and refractory chronic migraine headaches. For patients with chronic migraine headaches the response to combined systems appears to be substantially better than occipital nerve stimulation alone.
Subject(s)
Electric Stimulation Therapy/methods , Headache Disorders/therapy , Migraine with Aura/therapy , Adult , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Neck/innervation , Occipital Lobe/physiopathology , Orbit/innervation , Patient Satisfaction , Treatment Outcome , Young AdultABSTRACT
Atrial and junctional arrhythmias may occur after heart transplantation. Often these arrhythmias require intravenous beta-agonists or atrial pacing to improve posttransplant hemodynamic values. We describe a heart transplant patient with a hemodynamically significant junctional rhythm who responded to oral terbutaline with conversion to sinus rhythm.
