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Neuromodulation in primary headaches: current evidence and integration into clinical practice
Florian Rimmele1, Tim P Jürgens
1Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany.
Current Opinion in Neurology
|April 24, 2020
Summary
Neuromodulation offers new headache treatments, with noninvasive methods preferred. Invasive options are for severe, refractory cases, but more research is needed for optimal integration into treatment plans.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Neuromodulation is an emerging therapeutic strategy for primary headache disorders.
- This review synthesizes current evidence on neuromodulation techniques for headache management.
Purpose of the Study:
- To provide a comprehensive overview of controlled studies on neuromodulation for primary headaches.
- To offer recommendations for clinical practice regarding these techniques.
Main Methods:
- Review of current controlled studies on various neuromodulation techniques.
- Analysis of evidence for efficacy and safety.
Main Results:
- Transcutaneous vagal nerve stimulation (tVNS) shows limited efficacy in acute migraine and cluster headaches.
- Supraorbital/supratrochlear nerve stimulation has shown effectiveness in episodic migraines.
- Occipital nerve stimulation is an option for chronic refractory cluster headaches.
Conclusions:
- Noninvasive neuromodulation is preferred, complementing conventional therapies.
- Invasive procedures are reserved for severe, refractory headache cases.
- Further research, including head-to-head studies, is needed to establish neuromodulation's place in treatment algorithms.
