title: Central and Peripheral Neural Targets for Neurostimulation of Chronic Headaches.
abstract: OBJECTIVE
  Chronic headache sufferers are estimated to be around 3% of the population. These patients have a high disease burden. When prophylactic treatments have low efficacy and tolerability, patients are in need of alternative therapeutic strategies and options.
  
  
  RESULTS
  In the last decade, a number of neuromodulation procedures have been introduced as treatment of chronic intractable headache patients when pharmacological treatments fail or are not well tolerated. Neurostimulation of peripheral and central nervous system has been carried out, and now, various non-invasive and invasive stimulation devices are available. Non-invasive neurostimulation options include vagus nerve stimulation, supraorbital stimulation and single-pulse transcranial magnetic stimulation; invasive procedures include occipital nerve stimulation, sphenopalatine ganglion stimulation and hypothalamic deep brain stimulation. In many cases, results supporting their use derive from open-label series and small controlled trial studies. Lack of adequate placebo hampers adequate randomized controlled trials. In this paper, we give an overview on the main neurostimulation procedures in terms of results and putative mechanism of cation.
authors.affiliation: Department of Neurology, Headache Centre and Pain Neuromodulation Unit, Fondazione Istituto Nazionale Neurologico Carlo Besta, Via Celoria 11, 20133, Milano, Italy. leone@istituto-besta.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of Neurology, Headache Centre and Pain Neuromodulation Unit, Fondazione Istituto Nazionale Neurologico Carlo Besta, Via Celoria 11, 20133, Milano, Italy.
authors.forename: Alberto Proietti
authors.initials: AP
authors.lastname: Cecchini
mesh_terms: D004599:Electric Stimulation Therapy / Q000379:methods*; D020773:Headache Disorders / Q000628:therapy*; D006801:Humans
keywords: Chronic headache; Hypothalamic stimulation; Neuromodulation; Occipital stimulation; Sphenopalatine ganglion stimulation; Vagus nerve stimulation