Salkim, E; Demosthenous, A; (2020) Neuromodulators for Primary Headache Disorders: A Review. EC Neurology , 12 (8) pp. 223-236.

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Abstract

Primary headache disorders are among the most common and disabling globally. Pharmacological treatments are often insufficient, poorly tolerated, have side effects and the majority of patients are unable to complete their treatment. Understanding the neural pain pathways of these disorders has led to the development of alternative therapies. Electrical nerve stimulation is a form of pain modulation with few side effects for the treatment of primary headache disorders. Different neuromodulation approaches, both invasive and non-invasive, have rapidly led to new approaches for the treatment of patients suffering from headache, particularly those who have failed traditional pharmacotherapy. Non-invasive treatment methods are safe, practical and well-tolerated compared to alternatives. This paper details recent evidence-based advances in neuromodulators for primary headache disorders such as migraine and trigeminal autonomic cephalalgias (in particular, cluster headache) including non-invasive commercial devices used for migraine and cluster headache. The target neural structures, their advantages and disadvantages and their application in headache treatment are discussed. Examples of using neuromodulation to manage primary headache disorders are discussed. Both invasive stimulations e.g. of occipital and vagus nerves, the sphenopalatine ganglion, deep brain and spinal cord, and non-invasive, e.g. stimulation of the frontal, cervical and auricular vagus nerves, transcranial magnetic and transcranial direct current stimulation, are detailed.

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