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Neuromodulation for refractory headaches.

Giovanni Broggi1, Giuseppe Messina, Carlo Marras

  • 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|May 14, 2010
PubMed
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Neuromodulation offers safe and effective surgical options for severe, drug-refractory headaches when conservative treatments fail. Both central (deep-brain stimulation) and peripheral (vagus nerve, occipital nerve, trigeminal stimulation) methods show promise.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pain Management

Background:

  • Drug-refractory headaches significantly impair social functioning and quality of life.
  • Conservative treatments are often ineffective for severe primary and secondary headache disorders.
  • Surgical interventions are considered when conventional therapies fail.

Purpose of the Study:

  • To review the safety and efficacy of available neuromodulation procedures for severe headaches.
  • To discuss central and peripheral neuromodulation techniques.
  • To present the authors' institutional experience with these treatments.

Main Methods:

  • Literature review of central neuromodulation (deep-brain stimulation - DBS).
  • Literature review of peripheral neuromodulation (vagus nerve stimulation - VNS, occipital nerve stimulation - ONS, subcutaneous trigeminal stimulation).

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  • Inclusion of institutional experience with these neuromodulation techniques.

    • Main Results:

    • Neuromodulation procedures are generally safe and effective for a significant patient population.
    • Evidence supports the use of DBS, VNS, ONS, and subcutaneous trigeminal stimulation for severe headaches.
    • The authors' institute has experience with these reviewed neuromodulation approaches.

    Conclusions:

    • Neuromodulation represents a viable therapeutic option for patients with severe, intractable headaches.
    • Both central and peripheral neuromodulation techniques have demonstrated efficacy.
    • Further research and clinical application of neuromodulation are warranted for headache management.