Update on Neuromodulation for Migraine and Other Primary Headache Disorders: Recent Advances and New Indications

Neuromodulation techniques currently available for headache management are reviewed in this article, with a focus on recent advances in non-invasive devices for migraine and trigeminal autonomic cephalalgias.

The currently available FDA-cleared non-invasive devices for migraine include transcutaneous supraorbital and supratrochlear nerve stimulation, single-pulse transcranial magnetic stimulation (sTMS), external concurrent occipital and trigeminal neurostimulation (eCOT-NS), remote electrical neuromodulation (REN), and non-invasive vagal nerve stimulation (nVNS) with indications for migraine and trigeminal autonomic cephalalgias. Emerging non-invasive techniques being explored for use in migraine include transcranial direct current stimulation (tDCS), kinetic oscillation stimulation (KOS), and auricular transcutaneous vagal nerve stimulation (at-VNS). In addition to primary headache, non-invasive neuromodulation is being investigated for comorbid conditions such as depression. Non-invasive neuromodulation devices remain a safe, well-tolerated, and effective therapy for patients with primarily migraine and trigeminal autonomic cephalalgias. Ongoing research is needed to determine efficacy in other headache disorders and comorbid conditions.