Headache
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Neuromodulation is an emerging area in headache management. Through neurostimulation, multiple brain areas can be modulated to alleviate pain, hence reducing the pharmacological need. In this review, we discuss the recent development of the vagus nerve stimulation (VNS) for headache management. ⋯ Progression in nVNS clinical efficacy over time suggests an underlying disease-modifying neuromodulation. Noninvasive VNS appears to be as effective as the invasive counterpart for many indications. With an enormous potential therapeutic gain and a high safety profile, further development and application of nVNS is promising.
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Noninvasive and minimally invasive extracranial stimulation has now been widely investigated for the treatment of primary headache disorders, particularly migraine. In this review, we describe methodological challenges in studying occipital and supraorbital stimulation devices. We explore the efficacy and safety of implantable occipital nerve stimulation for primary headache disorders, including the 3 randomized, sham-controlled clinical trials for chronic migraine treatment. We also review noninvasive supraorbital transcutaneous stimulation as a preventive therapy for episodic migraine.
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To describe the history of and available data on sphenopalatine ganglion (SPG) neuromodulation in the treatment of headache up to the present. ⋯ Success rates for implanted SPG neuromodulation in the experimental phase of the European randomized controlled trial, in the open label extension trial, and in the registry of patients implanted outside of the trial remain at about two-thirds of patients implanted being responders, defined as being able to terminate at least 50% of attacks or having at least a 50% decrease in attack frequency or both. A US pivotal registration study is underway to confirm these results and obtain FDA approval for this treatment for cluster headache patients. Further studies in migraine are also underway.
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Observational Study
Psychological Factors Associated With Chronic Migraine and Severe Migraine-Related Disability: An Observational Study in a Tertiary Headache Center.
To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. ⋯ Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate the relationships among naturalistic variation in psychological factors, migraine-related disability, and migraine chronification.