Neuromodulation for Intractable Headaches

Abstract

Intractable chronic headaches are a major challenge for both patients and healthcare professionals. Over the last two decades, implantable electrical neuromodulators, previously established to manage other forms of chronic pain, have been used increasingly for intractable primary and secondary headache disorders. We review the current approaches to the management of refractory headaches using neuromodulation. Indications, operative considerations and complications are discussed based on our experience and a review of the literature. The field of neuromodulation has been rapidly advancing, with many new targets being discovered and novel devices being developed for treating craniofacial pain. We discuss some of these targets, detailing the latest advances in the area of neuromodulation for intractable headaches.

Vagus Nerve Stimulation

“…Patients may experience headache relief when used as needed, but the device can be used several times per day to prevent headaches. Pilot studies and case series reports using the gammaCore device for primary headache syndromes have been described in abstract form and larger controlled trials are underway [26], but this device has not been investigated in epilepsy or depression.…”

Interdisciplinary management of headache disorders

“…167 Both peripheral and central nervous system neuromodulation approaches are available as possible treatment options for treatment-refractory chronic headache disorders. Neuromodulation is a promising addition to a clinicians' "toolbox" in the management of refractory chronic headache disorders.…”

“…Neuromodulation is a promising addition to a clinicians' "toolbox" in the management of refractory chronic headache disorders. 167 Occipital nerve stimulation (ONS) is the most well-known and well-published peripheral neuromodulation procedure for the treatment of intractable headaches. ONS has been used to treat occipital neuralgia, [168][169][170][171] chronic migraine, 172,173 hemicrania continua, 174 SUNCT, 175 and cluster headache.…”

Vagus Nerve Stimulation and Headache

“…Neuromodulation is a growing field in headache management. Technology ranges from invasive deep brain stimulation (DBS) of the posterior hypothalamus, to minimally invasive percutaneous electrode implantation for occipital nerve stimulation, and noninvasive transcranial magnetic stimulation and transcranial direct current stimulation . Neurostimulation can be particularly useful to those who failed triptans or other prophylactic treatments .…”

“…Technology ranges from invasive deep brain stimulation (DBS) of the posterior hypothalamus, to minimally invasive percutaneous electrode implantation for occipital nerve stimulation, and noninvasive transcranial magnetic stimulation and transcranial direct current stimulation. [1][2][3] Neurostimulation can be particularly useful to those who failed triptans or other prophylactic treatments. 4 The European Headache Federation positioned that a neurostimulation device should only be used in medically intractable headache patient who has been evaluated at a tertiary headache center.…”