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Neurostimulation approaches to primary headache disorders
Thorsten Bartsch1, Koen Paemeleire, Peter J Goadsby
1Department of Neurology, University Hospital of Schleswig Holstein, University of Kiel, Germany.
Current Opinion in Neurology
|May 13, 2009
Summary
Neurostimulation offers a promising alternative for chronic headache syndromes like chronic migraine and cluster headache when medications fail. Invasive techniques such as occipital nerve stimulation and deep-brain stimulation show significant positive responses in patients.
Area of Science:
- Neurology
- Neurosurgery
- Pain Management
Background:
- Medically intractable chronic headache syndromes (chronic migraine, chronic cluster headache, hemicrania continua) have limited conventional management options.
- Neurostimulation presents an emerging therapeutic avenue for these debilitating conditions.
Purpose of the Study:
- To review current concepts, approaches, and outcome data for invasive device-based neurostimulation in chronic headache syndromes.
- To summarize the clinical potential of occipital nerve stimulation and deep-brain stimulation.
Main Methods:
- Review of recent studies on suboccipital neurostimulation for drug-resistant chronic headache.
- Analysis of outcomes for hypothalamic deep-brain stimulation in cluster headache patients.
Main Results:
- Suboccipital neurostimulation demonstrates efficacy in chronic headache syndromes, even decades after onset, for medication-refractory patients.
- Hypothalamic deep-brain stimulation in over 50 cluster headache patients yielded significant positive responses in 50-70%.
Conclusions:
- Neurostimulation, including occipital nerve stimulation and deep-brain stimulation, shows significant clinical potential for managing chronic headache syndromes.
- These findings support further investigation into neurostimulation as a viable treatment option for patients unresponsive to medication.
