title: Noninvasive neuromodulation in cluster headache.
abstract: OBJECTIVE
  Neuromodulation is an alternative in the management of medically intractable cluster headache patients. Most of the techniques are invasive, but in the last 2 years, some studies using a noninvasive device have been presented. The objective of this article is to review the data using this approach.
  
  
  RESULTS
  Techniques as occipital nerve stimulation or sphenopalatine ganglion stimulation are recommended as first-line therapy in refractory cluster patients, but they are invasive and maybe associated with complications. Noninvasive vagal nerve stimulation with an external device has been tried in cluster patients. Results from clinical practice and a single randomized clinical trial have been presented showing a reduction of the number of cluster attacks/week in the patients treated with the device. The rate of adverse events was low and most of them were mild.
  
  
  CONCLUSIONS
  In the last decade, invasive neuromodulation treatments have demonstrated good efficacy in cluster refractory patients. Noninvasive approaches such as the noninvasive vagal nerve stimulation have shown efficacy in one trial and could be an easier alternative in the management of this debilitating headache. We need to replicate these results with further controlled studies and conduct basic research in order to clarify the mechanism of action.
authors.affiliation: aDepartment of Neurology, Clinic University Hospital, Catholic University of Valencia, Valencia, Spain bDepartment of Neurology, Danish Headache Center, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Miguel J A
authors.initials: MJ
authors.lastname: Láinez
authors.forename: Rigmor
authors.initials: R
authors.lastname: Jensen
mesh_terms: D001921:Brain / Q000502:physiology*; D003027:Cluster Headache / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D014630:Vagus Nerve / Q000502:physiology*