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Neurostimulation approaches to primary headache disorders

Bartsch, Thorstena; Paemeleire, Koenb; Goadsby, Peter Jc

Current Opinion in Neurology: June 2009 - Volume 22 - Issue 3 - p 262–268
doi: 10.1097/WCO.0b013e32832ae61e
Headache: Edited by Peter Goadsby

Purpose of review Conventional management options in medically intractable chronic-headache syndromes, such as chronic migraine, chronic cluster headache and hemicrania continua, are often limited. This review summarizes the current concepts, approaches and outcome data of invasive device-based neurostimulation approaches using occipital-nerve stimulation and deep-brain stimulation.

Recent findings Recently, there has been considerable progress in neurostimulation approaches to medically intractable chronic-headache syndromes. Previous studies have analysed the safety and efficacy of suboccipital neurostimulation in drug-resistant chronic-headache syndromes such as in chronic migraine, chronic cluster headache and hemicrania continua. The studies suggest suboccipital neurostimulation can have an effect even decades after onset of headaches, thus representing a possible therapeutic option in patients that do not respond to any medication. Similarly, to date over 50 patients with cluster headaches underwent hypothalamic deep-brain stimulation. From these, an average of 50–70% did show a significant positive response.

Summary These findings will help to further elucidate the clinical potential of neurostimulation in chronic headache.

aDepartment of Neurology, University Hospital of Schleswig Holstein, University of Kiel, Germany

bDepartment of Neurology, Ghent University Hospital, Ghent, Belgium

cHeadache Group-Department of Neurology, University of California, San Francisco, San Francisco, California, USA

Correspondence to Professor Peter J. Goadsby, MD, PhD, Headache Group-Department of Neurology, University of California, San Francisco, 1635 Divisadero Street, San Francisco, CA 94115, USA E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.