[Neurostimulation: which place in the treatment of refractory headaches?]

The management of refractory headaches (migraine or cluster headache) is often challenging in clinical practice. Most of the time, these patients are "desperate" and have already tried all existing medications. Many progresses have recently been made in the therapeutic approach of these diseases, especially with the advent of neurostimulation techniques. In this review of the literature, we describe various neurostimulation methods which have been studied in clinical trials or case reports of refractory headaches. The most effective and best studied methods are occipital nerve stimulation (ONS) and hypothalamic deep brain stimulation (DBS), the latter being however at higher surgical risk. Hence, there is a new hope for patients with refractory headaches. Various clinical trials are still underway.