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.
Bartsch
Thorsten
T
Department of Neurology, University Hospital of Schleswig Holstein, University of Kiel, Germany.
Paemeleire
Koen
K
Goadsby
Peter J
PJ
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