title: Pearls and pitfalls: neurostimulation in headache.
abstract: BACKGROUND
  A variety of neuromodulatory approaches available today has broadened our therapeutic options significantly especially in drug refractory patients with chronic cluster headache and chronic migraine.
  
  
  BACKGROUND
  It is a dynamic field with a current trend to non-invasive transcutaneous stimulation approaches. However, sound studies providing evidence for the widespread use of these novel approaches are sparse. For invasive approaches, occipital nerve stimulation is now widely considered the treatment of first choice in chronic trigeminal autonomic cephalgias and - with limitations - chronic migraine. Although equally effective, deep brain stimulation is considered second-line treatment in cluster headache because of its potentially life-threatening side effects. Most recently, stimulation of the sphenopalatine ganglion has also been shown to effectively abort acute cluster headache attacks. Interesting other upcoming approaches include transcutaneous supraorbital nerve stimulation and transcutaneous vagal nerve stimulation.
  
  
  CONCLUSIONS
  Pearls and pitfalls of common invasive and non-invasive neuromodulatory approaches and open questions are summarised in this review along with recommendations for future studies.
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, D-22046 Hamburg, Germany. t.juergens@uke.de
authors.forename: Tim P
authors.initials: TP
authors.lastname: Jürgens
authors.forename: Massimo
authors.initials: M
authors.lastname: Leone
mesh_terms: D002908:Chronic Disease; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods*; D019317:Evidence-Based Medicine; D006261:Headache / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000517:prevention & control*; D009422:Nervous System Diseases / Q000209:etiology* / Q000517:prevention & control*
keywords: Migraine; cluster headache; deep brain stimulation; nerve stimulation; neuromodulation