Neurostimulators for the Treatment of Primary Headaches

Massimo Leone; Alberto Proietti Cecchini; Angelo Franzini; Gennaro Bussone


Future Neurology. 2013;8(4):457-467. 

In This Article

Abstract and Introduction


Neurostimulation techniques have increased our therapeutic armamentarium, providing additional options for the treatment of patients with drug-resistant headache. Occipital nerve stimulation can be considered in drug-resistant chronic cluster headache and, with more caution, in drug-resistant chronic migraine. Approximately 12 years after its introduction, hypothalamic stimulation is a valid option for drug-resistant chronic cluster headache to be considered when occipital nerve stimulation fails. Several other peripheral stimulation approaches (in addition to occipital nerve stimulation) have been introduced in recent years; however, for the most part, appropriate studies supporting their efficacy are lacking. Transcranial magnetic stimulation, transcutaneous supraorbital nerve stimulation, sphenopalatine ganglion stimulation and vagal nerve stimulation have all been tried, but results are not wholly convincing, and more extensive evaluations are required.


Headaches without an identifiable underlying cause (primary headaches) affect approximately 45% of the general population[1] and have a considerable socioeconomic impact.[2,3] Severe chronic headaches, where patients experience daily or almost-daily headache attacks, are highly disabling and have been estimated to affect approximately 1.4–2.2% of the population.[4] Although effective treatments are available for most primary headaches, a proportion of chronic headache sufferers are poor responders or intolerant to pharmacological treatments.

Neurostimulation techniques for treating primary headaches range from invasive deep brain stimulation to less invasive peripheral implantation and stimulation, and even less invasive transcranial stimulation. Central and peripheral neurostimulation techniques that have been applied to headache are extensively reviewed here; transcranial techniques are also considered. Their mechanisms of action and rationale for use are discussed, and the evidence for their effectiveness and safety is evaluated.