Chronic cluster headache (CCH) is a debilitating headache disorder often refractory to medical and interventional management. Historically, occipital nerve stimulation (ONS) has been used solely for preventative therapy.

We describe a case of a 68-year-old right-handed male with CCH who attained excellent and sustained pain relief with temporary bilateral ONS.

Prior to ONS he suffered from severe, daily cluster headaches occurring on average 1-3 times per day with episodes where headache frequency increased up to 10 times per day despite multiple medications and onabotulinumtoxin A injections following the PREEMPT protocol. Fluoroscopically guided sphenopalatine ganglion blocks yielded only short-term responses. He then underwent bilateral temporary peripheral nerve stimulator implantation targeting the greater occipital nerves for a 60-day treatment course.

At treatment conclusion, the patient’s headache frequency decreased to 4 episodes per month. This improvement in headache frequency continued to be observed 6 weeks after device removal. PROMIS pain interference t-scores improved from 60 (mild) at baseline to 41.6 (normal) at 3 months following initial lead implant.  PROMIS sleep interference t-scores improved from 68 (moderate) prior to treatment to 50.5 (normal) 3 months following implant.  During the 3 years following treatment, he experienced fewer attacks that better responded to acute treatment, had a period of headache freedom for over a year, and only reported two attacks in the final year of follow-up.

This case serves as proof of concept for the utilization of temporary 60-day, bilateral ONS as a transitional therapy for cluster headache. While previous studies demonstrate the utility of permanent ONS implant, this case represents a novel approach and suggests that sustained relief may be obtainable with only a 60-day treatment course. Prospective studies are needed to assess the long-term efficacy of extended 60-day ONS in cluster headache.