Non-Invasive Neuromodulation in the Treatment of Headache

This article aims to summarize the key evidence supporting the use of non-invasive neuromodulation devices in the treatment of various headache disorders in adults and children.

Over the last decade, different modalities have emerged for the non-invasive management of various headache disorders, with increasing evidence in recent years demonstrating their safety and efficacy in the treatment of migraine and trigeminal autonomic cephalgias, as well as other headache disorders. These devices include external trigeminal nerve stimulation (eTNS), transcutaneous electrical nerve stimulator (TENS), single-pulse transcranial magnetic stimulation (sTMS), non-invasive vagus nerve stimulation (nVNS), remote electrical neuromodulation (REN), and external concurrent trigeminal and occipital nerve neurostimulation (eCOT-NS). These non-pharmacologic options for the management of headache are safe, have evidence to support their use, and they are a particularly appealing option for patients vulnerable to the side effects of pharmacologic treatments or those who are looking to avoid them.