Neurostimulation approaches to primary headache disorders

  title={Neurostimulation approaches to primary headache disorders},
  author={Thorsten Bartsch and Koen Paemeleire and Peter J. Goadsby},
  journal={Current Opinion in Neurology},
Purpose of reviewConventional management options in medically intractable chronic-headache syndromes, such as chronic migraine, chronic cluster headache and hemicrania continua, are often limited. This review summarizes the current concepts, approaches and outcome data of invasive device-based neurostimulation approaches using occipital-nerve stimulation and deep-brain stimulation. Recent findingsRecently, there has been considerable progress in neurostimulation approaches to medically… 

Neurostimulation therapies for primary headache disorders: present and future.

Neurostimulation therapies inaugurate a new era in headache management and offer a promising alternative to medications, but future studies are necessary to provide evidence-based efficacy data, knowledge on their mode of action and information about their pharmaco-economic advantages.

Occipital nerve stimulation for headache disorders

Pearls and pitfalls: Neurostimulation in headache

Context A variety of neuromodulatory approaches available today has broadened our therapeutic options significantly especially in drug refractory patients with chronic cluster headache and chronic

Neuromodulatory Approaches to the Management of Medically Refractory Cluster Headache

It is shown that trigeminal denervation may not be effective in preventing the headache attacks or autonomic symptoms of chronic cluster headache, and modern neurostimulating approaches, such as stimulation of the greater occipital nerve and hypothalamic deep brain stimulation, supersede neurodestructive procedures.

Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: Initial experience

Combined occipital nerve–supraorbital nerve neurostimulation systems may provide effective treatment for patients with chronic migraine and refractory chronic migraine headaches.

Neurostimulation for Neck Pain and Headache

The current evidence for PNS in treatment of chronic migraine, trigeminal autonomic cephalagias and occipital neuralgia, and other secondary headache disorders is summarized.

Transcutaneous supraorbital neurostimulation for the prevention of chronic migraine: a prospective, open-label preliminary trial

A preliminary evaluation of the efficacy of the Cefaly® device for the prophylaxis of chronic migraine with or without medication overuse and over half the patients had a greater than 50% reduction in acute medication consumption.

Phenotype of patients responsive to occipital nerve stimulation for refractory head pain

It is concluded that careful clinical phenotyping may help in defining subgroups of patients with medically refractory headache that are more likely to respond to ONS, and medication overuse should be managed appropriately when considering ONS in migraine.

Occipital nerve stimulation for the treatment of chronic cluster headache - lessons learned from 18 months experience.

A prospective single-center observational trial in patients with refractory chronic cluster headache, including patients with ONS, to identify the best stimulation parameters and find the optimal parameters regarding pulse width and frequency is presented.



Neurostimulation in primary headache syndromes

  • P. Goadsby
  • Medicine, Psychology
    Expert review of neurotherapeutics
  • 2007
The initial results are encouraging and given the very significant disability of medically intractable primary headaches, this is a very promising area for patients and physicians alike.

Occipital Nerve Stimulation for Chronic Headache—Long-Term Safety and Efficacy

Occipital nerve stimulation may be effective in some patients with intractable headache, and results from prospective, randomized, sham-controlled studies in patients with medically refractory headache are needed.

Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients

Improvement occurred within days to weeks for those who responded most and patients consistently reported their attacks returned within hours to days when the device was off and one patient found that ONS helped abort acute attacks.

Deep Brain Stimulation for Intractable Chronic Cluster Headache: Proposals for Patient Selection

In five patients with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side-effects.

Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series.

Preliminary results indicate a role for posterior hypothalamic stimulation, which was demonstrated to be safe and effective, in the treatment of drug-resistant chronic CHs, and point to a central pathogenesis for chronicCHs.

Lessons From 8 Years' Experience of Hypothalamic Stimulation in Cluster Headache

Autonomic studies of patients undergoing posterior hypothalamic stimulation provide further evidence that long-term stimulation is safe, revealing that it can cause altered modulation of the mechanisms of orthostatic adaptation without affecting the baroreflex, cardiorespiratory interactions or efferent sympathetic and vagal functions.

Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study.

The activation pattern in the dorsal rostral pons is highly suggestive of a role for this structure in the pathophysiology of chronic migraine and the localization and persistence of activity during stimulation is exactly consistent with a region activated in episodic migraine, and with the persistence of activation of that area after successful treatment.

Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients.

The results of these open-label studies justify a larger, prospective trial but do not yet justify widespread clinical application of this technique.

Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action.

It is concluded that hypothalamic stimulation has remarkable efficacy in most, but not all, patients with treatment-resistant chronic cluster headache, and is not due to a simple analgesic effect or to hormonal changes.