Neurostimulation approaches to primary headache disorders – Source: Current Opinion in Neurology, Jun 2009

Purpose of Review: Conventional management options in medically intractable chronic-headache syndromes, such as chronic migraine, chronic cluster headache and hemicrania continua, are often limited. This review summarizes the current concepts, approaches and outcome data of invasive device-based neurostimulation approaches using occipital-nerve stimulation and deep-brain stimulation.

Recent Findings: Recently, there has been considerable progress in neurostimulation approaches to medically intractable chronic-headache syndromes. Previous studies have analysed the safety and efficacy of suboccipital [under or behind the suboccipital nerve – between base of skull & first cervical vertebra] neurostimulation in drug-resistant chronic-headache syndromes such as in chronic migraine, chronic cluster headache and hemicrania continua.

The studies suggest suboccipital neurostimulation can have an effect even decades after onset of headaches, thus representing a possible therapeutic option in patients that do not respond to any medication.

Similarly, to date over 50 patients with cluster headaches underwent hypothalamic deep-brain stimulation. From these, an average of 50%-70% did show a significant positive response.

Summary: These findings will help to further elucidate the clinical potential of neurostimulation in chronic headache.

Source: Current Opinion in Neurology, Jun 2009;22(3):262-8. PMID: 19434793, by Bartsch T, Paemeleire K, Goadsby PJ. Department of Neurology, University Hospital of Schleswig Holstein, University of Kiel, Germany.

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