Neurostimulation approaches to primary headache disorders.
OBJECTIVE
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.


RESULTS
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 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 inpatients 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.


CONCLUSIONS
These findings will help to further elucidate the clinical potential of neurostimulation in chronic headache.
Department of Neurology, University Hospital of Schleswig Holstein, University of Kiel, Germany.
Thorsten
T
Bartsch
Koen
K
Paemeleire
Peter J
PJ
Goadsby
D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003027:Cluster Headache / Q000628:therapy; D046690:Deep Brain Stimulation; D004599:Electric Stimulation Therapy; D020773:Headache Disorders / Q000628:therapy; D051270:Headache Disorders, Primary / Q000628:therapy*; D006801:Humans; D007031:Hypothalamus / Q000502:physiology; D009778:Occipital Lobe; D016896:Treatment Outcome