Abstract
Neuromodulation is a promising, novel approach for the treatment of primary headache disorders. Neuromodulation offers a new dimension in the treatment that is both easily reversible and tends to be very well tolerated. The autonomic nervous system is a logical target given the neurobiology of common primary headache disorders, such as migraine and the trigeminal autonomic cephalalgias (TACs). This article will review new encouraging results of studies from the most recent literature on neuromodulation as acute and preventive treatment in primary headache disorders, and cover some possible underlying mechanisms. We will especially focus on vagus nerve stimulation (VNS) and sphenopalatine ganglion (SPG) since they have targeted autonomic pathways that are cranial and can modulate relevant pathophysiological mechanisms. The initial data suggests these approaches will find an important role in headache disorder management going forward.
Highlights
Headache disorders are the most common form of disability on a global basis and the sixth most common cause of disability worldwide [1]
The majority of people affected by primary headache disorders can be classified as episodic, a percentage of patients develop chronic forms often resistant to regular pharmacological treatment, which result in an enormous burden for sufferers and difficulties for physicians
Even patients with less severe headache syndromes can develop noticeable side effects with medical therapy and require a constant pursuit for new treatment options. These growingly recognized problems have led to the expansion of an exciting new branch of headache treatment: neuromodulation. This group of techniques comprises non-invasive treatments which, by targeting the central or peripheral nervous system, aim at modifying pain and other mechanisms involved in headache, and more invasive surgical approaches directed towards structures directly involved in the genesis of specific headache syndromes
Summary
Headache disorders are the most common form of disability on a global basis and the sixth most common cause of disability worldwide [1]. Even patients with less severe headache syndromes can develop noticeable side effects with medical therapy and require a constant pursuit for new treatment options. These growingly recognized problems have led to the expansion of an exciting new branch of headache treatment: neuromodulation. This group of techniques comprises non-invasive treatments which, by targeting the central or peripheral nervous system, aim at modifying pain and other mechanisms involved in headache, and more invasive surgical approaches directed towards structures directly involved in the genesis of specific headache syndromes. We have been tasked to cover neuromodulation of autonomic pathways plausibly intersecting with migraine [7, 8] and trigeminal autonomic cephalalgia (TAC, [9]) neurobiology
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