Electrical stimulation in headache treatment. For separate headache(s) or for headache generally?

Area of Science:

• Neurology
• Neurosurgery

Background:

• Unilateral severe headaches pose diagnostic and therapeutic challenges.
• Cervicogenic headache (CEH) and hemicrania continua (HC) present with distinct but sometimes overlapping symptoms.

Observation:

• Two patients with severe unilateral headaches underwent epidural/epicranial electrical stimulation.
• One patient had CEH, while the other presented with features resembling HC but with poor indomethacin response and severe pain.
• Electrode placement varied: foramen magnum in CEH, and preauricular area in the second case.

Findings:

• Both patients experienced immediate and significant headache relief following electrical stimulation.
• The positive response was sustained long-term, exceeding five years post-implantation in both cases.
• The second patient's condition, termed 'non-indomethacin-responsive chronic hemicrania', suggests a potentially unrecognized headache entity.

Implications:

• Epidural/epicranial electrical stimulation is a promising, long-term treatment for specific severe unilateral headaches.
• This neuromodulation approach may offer an alternative for patients refractory to conventional therapies.
• Further research is warranted to define the scope and efficacy of this treatment for various chronic headache disorders.