Occipital Nerve Stimulation for Migraine: Update from Recent Multicenter Trials

Schwedt, Todd J.; Green, A. Laine; Dodick, David W.

doi:10.1159/000434662

Cited by 10 publications

(2 citation statements)

References 30 publications

(33 reference statements)

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“…Some patients who are non-responders to these treatments choose to undergo surgical implantation of invasive nerve stimulators to relieve pain [10]. A component of some of these treatment options is caffeine, a non-specific adenosine receptor antagonist [11].…”

Section: Introductionmentioning

confidence: 99%

The Role of Adenosine Signaling in Headache: A Review

2017

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Migraine is the third most prevalent disease on the planet, yet our understanding of its mechanisms and pathophysiology is surprisingly incomplete. Recent studies have built upon decades of evidence that adenosine, a purine nucleoside that can act as a neuromodulator, is involved in pain transmission and sensitization. Clinical evidence and rodent studies have suggested that adenosine signaling also plays a critical role in migraine headache. This is further supported by the widespread use of caffeine, an adenosine receptor antagonist, in several headache treatments. In this review, we highlight evidence that supports the involvement of adenosine signaling in different forms of headache, headache triggers, and basic headache physiology. This evidence supports adenosine A2A receptors as a critical adenosine receptor subtype involved in headache pain. Adenosine A2A receptor signaling may contribute to headache via the modulation of intracellular Cyclic adenosine monophosphate (cAMP) production or 5' AMP-activated protein kinase (AMPK) activity in neurons and glia to affect glutamatergic synaptic transmission within the brainstem. This evidence supports the further study of adenosine signaling in headache and potentially illuminates it as a novel therapeutic target for migraine.

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Section: Introductionmentioning

confidence: 99%

The Role of Adenosine Signaling in Headache: A Review

2017

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“…In patients with refractory migraine, surgical options, like invasive occipital nerve stimulation (ONS), may be considered. ONS has possible support from systematic review and meta-analyzes ( 17 , 148 , 149 ), however the studies are prone to bias due to small size and difficulty blinding with safety concerns including lead migration, infection and pain ( 150 , 151 ). Long-term studies on ONS are limited in migraine, with the majority done in cluster headache, but persistence of benefit is reported ( 152 , 153 ).…”

Section: Management Of Patients With Refractory Migrainementioning

confidence: 99%

Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine

Robblee

2023

Front. Neurol.

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BackgroundRefractory migraine is a poorly described complication of migraine in which migraine has chronified and become resistant to standard treatments. The true prevalence is unknown, but medication resistance is common in headache clinic patient populations. Given the lack of response to treatment, this patient population is extremely difficult to treat with limited guidance in the literature.ObjectiveTo review the diagnostic, pathophysiological, and management challenges in the refractory migraine population.DiscussionThere are no accepted, or even ICHD-3 appendix, diagnostic criteria for refractory migraine though several proposed criteria exist. Current proposed criteria often have low bars for refractoriness while also not meeting the needs of pediatrics, lower socioeconomic status, and developing nations. Pathophysiology is unknown but can be hypothesized as a persistent “on” state as a progression from chronic migraine with increasing central sensitization, but there may be heterogeneity in the underlying pathophysiology. No guidelines exist for treatment of refractory migraine; once all guideline-based treatments are tried, treatment consists of n-of-1 treatment trials paired with non-pharmacologic management.ConclusionRefractory migraine is poorly described diagnostically, its pathophysiology can only be guessed at by extension of chronic migraine, and treatment is more the art than science of medicine. Navigating care of this refractory population will require multidisciplinary care models and an emphasis on future research to answer these unknowns.

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Muehlberger¹

2018

Migraine Surgery

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Occipital Nerve Stimulation for Migraine: Update from Recent Multicenter Trials

Cited by 10 publications

References 30 publications

The Role of Adenosine Signaling in Headache: A Review

The Role of Adenosine Signaling in Headache: A Review

Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine

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