• Timothy R Deer, Nagy Mekhail, Erika Petersen, Elliot Krames, Peter Staats, Jason Pope, Youssef Saweris, Shivanand P Lad, Sudhir Diwan, Steven Falowski, Claudio Feler, Konstantin Slavin, Samer Narouze, Lotfi Merabet, Asokumar Buvanendran, Felipe Fregni, Joshua Wellington, Robert M Levy, and Neuromodulation Appropriateness Consensus Committee.
• Center for Pain Relief, Charleston, WV, USA.
• Neuromodulation. 2014 Aug 1;17(6):551-70; discussion 570.

IntroductionThe International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain.MethodsThe INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors.ResultsThe NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational.ConclusionsThe NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.© 2014 International Neuromodulation Society.

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