Treatment of hemicrania continua by non-invasive vagus nerve stimulation in 2 patients previously treated with occipital nerve stimulation

Hemicrania Continua is an indomethacin sensitive chronic primary headache syndrome consisting of constant unilateral pain with severe cranial autonomic exacerbations. Long-term indomethacin use can be associated with side effects, resulting in discontinuation of the drug in some patients. Current neuromodulation approaches to treatment, including occipital nerve stimulation (ONS), all require surgical implantation. A novel alternative treatment for this disorder is therefore needed. We assessed the usefulness of a new non-invasive, portable vagus nerve stimulation (VNS) device, the GammaCore, in two patients who were unable to take indomethacin. Both had previously responded to ONS with the Bion implant[1], but had subsequently had it explanted.