Peripheral Neuromodulation for the Management of Headache.

Area of Science:

• Neurology
• Biomedical Engineering
• Pain Management

Background:

• Neuromodulation is an emerging therapeutic strategy for headache management, targeting nervous system structures implicated in headache pathophysiology.
• Pharmaceutical treatments are available, but technological advancements are crucial for exploring alternative modalities.
• Peripheral neuromodulation devices have gained FDA approval for specific headache types, especially in treatment-refractory cases.

Purpose of the Study:

• To provide a comprehensive overview of neurostimulatory implants for headache treatment.
• To review the efficacy and preliminary outcomes of available and developing neurostimulation devices.
• To discuss the limitations of current neurostimulatory treatments for headaches.

Main Methods:

• A narrative review was conducted.
• Literature search performed on PubMed, Google Scholar, Medline, and ScienceDirect from 1990 to 2019.
• Keywords included: Peripheral Neuromodulation, Headache, vagus nerve, occipital nerves, sphenopalatine ganglion.

Main Results:

• Noninvasive devices like Cefaly (external trigeminal nerve stimulation) and SpringTMS (transcranial magnetic stimulation) are FDA-approved for migraine.
• GammaCore, a handheld vagal nerve stimulator, is used for cluster headaches and migraines.
• Invasive devices, such as the SPG Microstimulator and occipital nerve stimulator (ONS), are also detailed, targeting specific neural pathways.

Conclusions:

• Neurostimulatory implants represent a significant advancement in headache treatment.
• Available devices show promise in improving patient outcomes for various headache disorders.
• Further research and development are ongoing for novel neuromodulation therapies.