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Advances and challenges in neurostimulation for headaches
Delphine Magis1, Jean Schoenen
1Headache Research Unit, Department of Neurology, University of Liège, Belgium.
The Lancet. Neurology
|July 21, 2012
Summary
Neurostimulation offers new hope for drug-resistant primary headache sufferers. Occipital nerve stimulation and deep brain stimulation show promise for chronic cluster headache and migraine.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Primary headache disorders affect many individuals resistant or intolerant to conventional pharmacotherapy.
- Neurostimulation techniques have emerged as potential therapeutic alternatives.
Purpose of the Study:
- To review the current landscape of central and peripheral neurostimulation for primary headache disorders.
- To evaluate the efficacy and safety of various neurostimulation modalities.
Main Methods:
- Systematic review of neurostimulation techniques including deep brain stimulation (DBS), occipital nerve stimulation (ONS), and transcranial magnetic stimulation (TMS).
- Analysis of data from approximately 1200 patients worldwide who have undergone these procedures.
Main Results:
- Occipital nerve stimulation (ONS) and deep brain stimulation (DBS) of the posterior hypothalamus demonstrate effectiveness in chronic cluster headache.
- ONS shows promise for chronic migraine management.
- Sham-controlled trials are limited, and the exact mechanisms of action require further elucidation.
Conclusions:
- Neurostimulation, particularly ONS and DBS, offers viable treatment options for refractory primary headaches.
- Future research should prioritize minimally invasive and non-invasive neurostimulation techniques due to their favorable risk-benefit profile.
