Neuromodulation for Chronic Daily Headache

Abstract

Purpose of review: We reviewed the literature that explored the use of central and peripheral neuromodulation techniques for chronic daily headache (CDH) treatment.

Recent findings: Although the more invasive deep brain stimulation (DBS) is effective in chronic cluster headache (CCH), it should be reserved for extremely difficult-to-treat patients. Percutaneous occipital nerve stimulation has shown similar efficacy to DBS and is less risky in both CCH and chronic migraine (CM). Non-invasive transcutaneous vagus nerve stimulation is a promising add-on treatment for CCH but not for CM. Transcutaneous external trigeminal nerve stimulation may be effective in treating CM; however, it has not yet been tested for cluster headache. Transcranial magnetic and electric stimulations have promising preventive effects against CM and CCH. Although the precise mode of action of non-invasive neuromodulation techniques remains largely unknown and there is a paucity of controlled trials, they should be preferred to more invasive techniques for treating CDH.

Keywords: Deep brain stimulation; Direct current stimulation; Occipital nerve; Sphenopalatine ganglia; Transcranial magnetic stimulation; Trigeminal nerve; Vagus nerve.

Fig. 1

Schematic representation of the sites of possible neuromodulatory intervention in chronic daily headaches. A Transcranial magnetic stimulation on the scalp, B direct current stimulation on the scalp, C transcutaneous stimulation of the supraorbital branch of the trigeminal nerve, D transcutaneous stimulation of the vagus nerve at the neck, E percutaneous stimulation of the great occipital nerve, and F deep brain stimulation of the posteroinferior hypothalamus or ventral tegmentum (Created with BioRender.com)