title: Neuromodulation of chronic headaches: position statement from the European Headache Federation.
abstract: The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.
authors.forename: Paolo
authors.initials: P
authors.lastname: Martelletti
authors.forename: Rigmor H
authors.initials: RH
authors.lastname: Jensen
authors.forename: Andrea
authors.initials: A
authors.lastname: Antal
authors.forename: Roberto
authors.initials: R
authors.lastname: Arcioni
authors.forename: Filippo
authors.initials: F
authors.lastname: Brighina
authors.forename: Marina
authors.initials: M
authors.lastname: de Tommaso
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzini
authors.forename: Denys
authors.initials: D
authors.lastname: Fontaine
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.forename: Tim P
authors.initials: TP
authors.lastname: Jürgens
authors.forename: Massimo
authors.initials: M
authors.lastname: Leone
authors.forename: Delphine
authors.initials: D
authors.lastname: Magis
authors.forename: Koen
authors.initials: K
authors.lastname: Paemeleire
authors.forename: Stefano
authors.initials: S
authors.lastname: Palmisani
authors.forename: Walter
authors.initials: W
authors.lastname: Paulus
authors.forename: Arne
authors.initials: A
authors.lastname: May
mesh_terms: D059350:Chronic Pain / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006261:Headache / Q000628:therapy*; D020773:Headache Disorders / Q000628:therapy*; D006801:Humans; D050781:Transcranial Magnetic Stimulation / Q000379:methods*